Elsevier

European Journal of Cancer

Volume 50, Issue 3, February 2014, Pages 475-480
European Journal of Cancer

Policy statement on multidisciplinary cancer care

https://doi.org/10.1016/j.ejca.2013.11.012Get rights and content

Abstract

Background

Cancer care is undergoing an important paradigm shift from a disease-focused management to a patient-centred approach, in which increasingly more attention is paid to psychosocial aspects, quality of life, patients’ rights and empowerment and survivorship. In this context, multidisciplinary teams emerge as a practical necessity for optimal coordination among health professionals and clear communication with patients. The European Partnership for Action Against Cancer (EPAAC), an initiative launched by the European Commission in 2009, addressed the multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based multidisciplinary teams (MDTs) should include. To that effect, a working group conference was held in January 2013 within the EPAAC Work Package 7 (on Healthcare) framework.

Methods

The consensus group consisted of high-level representatives from the following European scientific societies, patient associations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS),European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE) and EPAAC Work Packages 5 (Health promotion and prevention), 7, 8 (Research), 9 (Information systems) and 10 (Cancer plans). A background document with a list of 26 core issues drawn from a systematic review of the literature was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical assessment, patients’ rights and empowerment and policy support. Preliminary drafts of the document were widely circulated for consultation and amendments by the working group before final approval.

Results

The working group unanimously formulated a Policy Statement on Multidisciplinary Cancer Care to define the core elements that should be implemented by all tumour-based MDTs. This document identifies MDTs as the core component in cancer care organisation and sets down the key elements to guide changes across all European health systems.

Conclusion

MDTs are an essential instrument of effective cancer care policy, and their continued development crucial to providing patients the care they need and deserve. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation. This policy statement is intended to serve as a reference for policymakers and healthcare providers who wish to improve the services currently provided to the cancer patients whose lives and well-being depend on their action.

Introduction

Optimal decision-making in the diagnosis, treatment and support of cancer patients is being increasingly associated with multidisciplinary teams (MDTs) [1]. Cancer care involves a growing number of specialists and health professionals as intervention areas expand to encompass psychosocial support, genetics and frailty aspects (among other areas) and consensus decisions are needed at all stages of care. As the care pathway becomes more complex, the potential for miscommunication, poor coordination between providers and fragmentation of services increases. This constitutes a challenge for patients and families as well as for caregivers.

MDTs were identified by the Lisbon roundtable (Portuguese European Union (EU) Presidency, 2007) as the best approach to organising cancer care in a way that consistently brings together all healthcare professionals involved in cancer diagnosis and treatment [2], and the EU Parliament and Council has also expressed support for these teams as a way to cope with coordination and communication issues associated with the implementation of the European reference networks for rare diseases [3]. Likewise, several European cancer control plans stress the importance of multidisciplinary care, setting specific guidance for its implementation [4], [5]. However, this prioritisation coexists with significant differences in performance, implementation and organisation of cancer care and access across countries [6], [7] as well as in policy measures taken to promote this approach. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation.

To that effect, the European Partnership for Action Against Cancer (EPAAC), launched by the European Commission in 2009, identified multidisciplinary care as a key element in cancer care [8], [9]. Work Package 7 (on Healthcare) initiated a process based on research and discussion among European stakeholders, which has led to the present statement. Firstly, a systematic review of the evidence was carried out, which showed how MDTs resulted in better clinical and process outcomes for cancer patients in terms of survival and reduction of waiting time from diagnosis to treatment [10]. However, the benefits of a team approach extend to multiple dimensions of care delivery, with many papers reporting improvements in patients’ quality of life and access to clinical trials as well as in the coordination of services. The MDT organisational approach is evolving towards an expanded role that embraces the whole process of patient care, from diagnosis to follow-up [11].

In addressing the policy approach to multidisciplinary care, a working group comprising key European stakeholders was organised. A background document with a list of 26 core issues drawn from the review was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical information and assessment, patients’ rights and empowerment and policy support. The discussion took place during the WP7 meeting in Barcelona on 31st January 2013 and involved high-level representatives from European scientific societies, European patient associations and European stakeholders, along with the EPAAC Work Packages on Health Promotion and Prevention, Research, Information Systems and Cancer Plans.

The working group unanimously formulated a policy statement to define the core elements that should be implemented by all tumour-based MDTs. Preliminary drafts of this Policy Statement on Multidisciplinary Cancer Care were widely circulated for consultation and amendments by the working group before final approval.

Section snippets

Rationale and definition of multidisciplinary teams (MDTs)

The working group stated MDTs’ underlying rationale in accordance to the following remarks:

  • Given the multiple benefits of MDTs and the imperative to equitably provide all patients with the best possible care, the promotion of MDTs should be considered an ethical priority.

  • Because of the consensus mechanisms that MDTs imply, including verification that decisions are consistent with available evidence, fostering MDTs is imperative to ensuring appropriate clinical decisions.

  • Multidisciplinary

Care objectives

The confirmation of a cancer diagnosis should prompt the initiation of multidisciplinary team (MDT) monitoring, including all the diagnostic and therapeutic specialties involved in the care process. Patients’ early access to the MDT should ensure that appropriate treatment is selected based on the preoperative assessment of imaging and pathology results. After staging, MDT consensus and patient consent on an evidence-based treatment plan is required for every cancer patient. This

Conclusion

The discussion carried out to reach consensus on these elements involved the effective exchange of best practices and criteria for successful implementation among scientific societies, patients and other European stakeholders. In this process, no assumptions were made that the issues surrounding multidisciplinary models of organisation had been resolved or that they were an exclusive concern of healthcare providers. The discussion revealed considerable consensus with regard to some perspectives

Role of funding source

This publication arises from the European Partnership for Action Against Cancer (EPAAC), which has received funding from the European Union through the Executive Agency for Health and Consumers of the European Commission, in the framework of the Health Programme 2008–2013. The European Commission is not responsible for the content of this publication and has had no role in the elaboration or the writing process of the document.

Conflict of interest statement

None declared.

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This policy statement on multidisciplinary cancer care is the result of a workshop carried out in the framework of the European Partnership for Action Against Cancer (EPAAC). It has been elaborated with the participation of representatives of the following scientific societies, patients’ organisations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS), European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE), EPAAC Work Packages 5 (Health promotion and prevention), 7 (Healthcare), 8 (Research), 9 (Information systems) and 10 (Cancer plans).

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