Why patients benefit from multidisciplinary cancer care

Cancer care can be complex. For the best outcomes it is important to treat a patient holistically, whether it is breast, lung, blood, colorectal or other cancers. Patients are managed by different specialists from different fields and can benefit from a combination of different types of treatment.

This is where multidisciplinary care comes in. A core tenet of care at the National Cancer Centre Singapore (NCCS), multidisciplinary care is delivered by the largest consolidation of cancer specialists in Singapore who provide patients with carefully tailored treatment plans for every step of their cancer journey.

At the National Cancer Centre Singapore, multidisciplinary tumour boards convene regularly to review patient cases to ensure the most appropriate and effective care is delivered.

What is multidisciplinary care?

Multidisciplinary care is an approach that brings together specialised professionals with the main goal of improving treatment efficiency and patient outcomes. In cancer care, a multidisciplinary approach is increasingly necessary because of constantly evolving recommendations for diagnostics, treatment and availability of clinical trials.

An approach that began over 30 years ago in oncology care, multidisciplinary teams discuss patient cases regularly to provide personalised treatment recommendations, according to the latest guidelines and treatments available. At NCCS, this is typically done in, but not limited to, three settings: the multidisciplinary hub in specialist outpatient clinics, multidisciplinary tumour clinics and multidisciplinary tumour boards.

Multidisciplinary hubs and co-integration of clinical care and research

On clinic floors, healthcare teams meet in multidisciplinary hubs to discuss and plan personalised care for their patients. Located behind consultation rooms, they provide space for medical teams made of up oncologists, surgeons, and nurses to discuss and consult each other on patient care plans. This makes it possible for patients to receive timely, tailored personalised treatment plans which may include a combination of chemotherapy, radiation therapy, surgery and medication.

In addition, each cancer type has its own dedicated space for consultation and research on each floor. Consultations, scans, biopsies and treatment are done in close proximity to make visits more convenient and comfortable for patients. Research labs are closely located to clinics and enable clinicians and researchers to work together to conduct research based on patients’ needs seen in the clinic.

Multidisciplinary tumour clinics

A team of specialists see patients at NCCS’ Lung Multidisciplinary Clinic.

Patients with complex cancer conditions are seen at multidisciplinary tumour clinics, which serve as one-stop clinics for cancer patients who need multidisciplinary treatment. Patients are seen by different specialties at the same appointment, which is especially beneficial for those who need a combination of treatment modalities and for whom treatment choice and sequence is important.

For example, a patient with locally advanced stage 3 lung cancer, may benefit from both systemic treatment, such as chemotherapy or immunotherapy, as well as a local therapy such as radiotherapy or surgery. Depending on the patient, a combination of these treatments may be recommended. Discussions with specialists from different disciplines can facilitate timely decision-making and expedite the start of treatment, which in turn optimises treatment outcomes for the patient.

At NCCS, the Lung Multidisciplinary Clinic is held weekly for patients with complex lung cancer to consult two or more specialists from different fields, at one visit. The team is made up of medical oncologists, cardiothoracic surgeons, radiation oncologists from NCCS and Singapore General Hospital with expertise in complex lung cancer management.

Similarly, the Comprehensive Liver Cancer Clinic at NCCS is dedicated to the treatment of primary liver cancer, hepatocellular carcinoma (HCC), and other cancers that have spread to the liver. Treatments for liver cancer are developing very rapidly and the cause and presentation of the disease varies, making it difficult for oncologists to follow a single set of guidelines. The multidisciplinary team is able to plug this gap and comprehensively assess the patient’s unique case and recommend the best available treatment.

Multidisciplinary tumour boards

The multidisciplinary approach at NCCS is reinforced by the numerous multidisciplinary tumour boards available for various disease and patient groups. They regularly meet to review patient cases and ensure that the most appropriate and effective care is delivered. At NCCS, tumour boards include those for gastro-intestinal cancers, geriatric patients, thoracic, head and neck cancers, lymphoma, molecular tumour board, rare cancers, women’s cancers and more.

The Molecular Tumour Board: A novel approach for hard-to-treat cancers

The Molecular Tumour Board (MTB) at NCCS is an example of a novel multidisciplinary tumour board that was started to find solutions for patients whose cancers no longer respond to systemic treatment. The MTB reviews and identifies patients suitable for molecular profiling to better understand the biological underpinnings of the disease and explore treatments that are potentially more effective. In some cases, this involves therapeutics on expanded access or enrolment on a clinical trial.

Seventy-six-year-old retiree, Mr Nadarajah, is a NCCS patient who benefitted from the MTB. He consulted a GP when he noticed a growing lump in his underarm and was referred to a skin specialist. A biopsy confirmed it was cancerous. Initially diagnosed with sarcoma, Mr Nadarajah received immunotherapy to control the cancer. However, after several rounds, the immunotherapy stopped working to shrink the tumour. In consultation with the MTB, the tumour underwent profiling and it was found that Mr Nadarajah had stage 4 non-small cell lung cancer. Results suggested that a targeted therapy which was not yet approved for use in lung cancer may be beneficial. His oncologist applied for expanded access and compassionate provision of the oral targeted therapy for Mr Nadarajah. He continues to take it till today and his cancer is under control.

References:

Taberna M, Gil Moncayo F, Jané-Salas E, Antonio M, Arribas L, Vilajosana E, Peralvez Torres E and Mesía R (2020) The Multidisciplinary Team (MDT) Approach and Quality of Care. Front. Oncol. 10:85. doi: 10.3389/fonc.2020.00085