Multidisciplinary Team Approach Is Integral to Oncology Care

Treating and caring for patients with cancer can require a complex team of medical professionals who work together toward a common goal. This type of approach emerged in the 1980s with the addition of chemotherapy to radiotherapy and/or surgery to improve survival outcomes for patients with cancer. In addition to the medical, surgical, and radiation oncologists, many other team members are needed to assist with more complex treatments. Other key members of the multidisciplinary team may include a nurse case manager/navigator, dietitian, physical therapist, social worker, psychologist, palliative care staff, onco-geriatrician, oncology pharmacists, and financial counselor.^1,2 Unfortunately, not all patients who need this support are able to receive it due to a lack of resources or ancillary support in some clinical settings.

The majority of malignancies demonstrate an increased incidence with age. The use of a multidisciplinary geriatric assessment in older patients can be beneficial in planning for treatments in this population.¹ For example, gastrointestinal cancers represent a challenge for older adults who may need multimodality treatments such as surgery, chemotherapy, and radiation therapy. Surgery complications can lead to nutritional issues such as malabsorption and delayed gastric emptying. Adverse effects of narcotics and polypharmacy issues are also frequent problems. A multidisciplinary geriatric assessment can uncover issues to be addressed before treatment starts, such as the need for nutritional support, physical therapy, pharmacy evaluation, and medication education.²

Another example is the expanded use of novel agents and alternative donors for hematopoietic stem cell transplantation for older patients with blood cancers. A multidisciplinary team is important in caring for these patients and assessing their needs prior to and during their treatment, including physical therapy, nutrition consultations, and psychological evaluation. Early identification and interventions can mitigate some of these risk factors.

As we become more successful in our oncology treatments, cancer survivors are living longer and facing many challenges created by the cancer or the therapies. Therefore, our multidisciplinary care does not end when their active cancer treatment has been completed. Issues such as fatigue, pain, osteoporosis, cardiac toxicity, nutritional challenges, neuropathy, and cognitive decline are only a subset of potential long-term issues they may face.

Our multidisciplinary care must continue far beyond the actual treatment. Addressing survivorship issues requires a coordinated team and the use of survivorship care plans that include key information on the treatment and assessment of ongoing toxicities, education on potential long-term toxicities, and overall health and wellness counseling. Survivorship education should include tailored individual information for the patient, the treatment received, and strategies to boost their health
and wellness.

REFERENCES

1. Presley CJ, Krok-Schoen JL, Wall SA, et al. Implementing a multidisciplinary approach for older adults with cancer: geriatric oncology in practice. BMC Geriatr. 2020;20(1):231. doi:10.1186/s12877-020-01625-5
2. Taberna M, Gil Moncayo F, Jané-Salas E, et al. The multidisciplinary team (MDT) approach and quality of care. Front Oncol. 2020;10:85. doi:10.3389/fonc.2020.00085