Team Players

Yesterday I had the privilege of moderating a roundtable event that focused on using a multi-disciplinary team approach to care for patients with colorectal cancer.  The meeting involved a treatment team from M. D. Anderson in Houston, who presented how this approach to care works in their hospital.  We then spent the bulk of the day in dialogue among the participants, who represented nearly a dozen organizations working in the field of colorectal cancer.

In the meeting we addressed three questions:

--Does a multidisciplinary team approach result in better outcomes for patients?

--If so, what are the barriers that prevent this approach from being utilized everywhere?

--What can we, the participants in the roundtable, do to change this?

The answer to the first question is a resounding, “Yes!”  A multidisciplinary team approach is better for patients—particularly for patients with metastases to the liver.  The science around managing liver tumors has changed dramatically in the past few years, and these changes require close cooperation between the oncologist, the liver surgeon, and the radiologist.  The traditional approach to this cooperation is through a consultation.  One doctor will call another one, send over charts, and ask for an opinion.  Or, the oncologist will look at the liver scans, decide that surgery is impossible, and not even confer with a surgeon.

In a multidisciplinary team approach, the doctors all sit down together in a room and discuss patients one at a time.  They look together at charts, at scans, at test results, and the reach consensus on the best treatment approach.  This has several advantages.  It encourages a synergy of ideas.  It allows for debate when the best treatment is unclear.  And it helps prevent anything from being overlooked.

More than this, the team working together helps ensure that short-term gains do not close off long-term options.  For example, if the tumors in a liver are too numerous or large to be removed through surgery, it is possible to shrink the tumors through chemotherapy or other techniques.  But, if too much chemotherapy is given, the liver might be so damaged it can’t recover from surgery.  Finding the right amount of chemotherapy requires that the oncologist and surgeon work closely together.

Another great aspect of a multidisciplinary team approach is this:  the team includes more than just the doctors.  Nurses, physician assistants, and other staff are in these meetings.  This means the doctors benefit from hearing about the patient from a more personal perspective.  Does the patient have a support network?  Are they willing to go through another surgery?  How are they tolerating the chemotherapy?  Are they likely to go through with the treatment plan? 

This approach has the capacity to transform a patient into a person.  And this is a rare and wonderful thing.

So why isn’t this method being used everywhere?  More on that later….