In the Introduction to "NHS Cancer Plan, Three Year Progress Report - Maintaining the Momentum" the National Cancer Director, Professor Mike Richards, said that the establishment of specialist cancer teams across the country has been one of the most important developments in recent years. "These multidis-ciplinary teams bringing together surgeons, radiologists, pathologists, oncologists, palliative care specialists and other professionals are now helping to ensure that patients receive appropriate investigations and treatment and they are helping to deliver co-ordinated care within the hospitals." He also said "The primary secondary and tertiary level services need to work closely together and that is what has been achieved by the Cancer Networks, which facilitate service planning and co-ordination across the institutional boundaries" .
The advantages of a multidisciplinary team looking after thyroid cancer are well known and have been detailed in the recent Improving Outcomes Guidance (IOG) by NICE . The most important benefit of multidisciplinary working is that each individual patient gets the most appropriate treatment decision made by a team of experts. It is possible to consider each single patient from a range of view points from people with different areas of expertise. This ensures that each patient is offered the best possible treatment currently available. Structured organization of MDT meetings is crucial so that different professionals can make their contribution without being present for the whole of the meeting if this is not necessary, thereby saving staff time. The key requirement is that each discipline is able to contribute independently to the decisions so that individual patients get the most appropriate treatment decision.
It can also improve communication and coordination of communication between professionals and patients and carers and coordination throughout the service. It is an effective framework for maintaining uniformity of treatment delivery across the country. Auditable standards will lead to improving the service continually. Continuing professional development of members and adherence to published guidelines can be supported and monitored.
It also speeds up and streamlines the referral process and thereby reduces undesirable delay in starting treatment.
The disadvantage of course is that this is quite time intensive and is resource dependent. Proper resourcing of manpower and facilities are required for the professionals to provide the time necessary for regular multidisciplinary meetings.
Each thyroid MDT should be typically covering a population base of 1 million in the UK and it may not be possible to institute all the recommendations at once. Therefore prioritization is going to have to be made and desirable MDT functioning can only be achieved gradually over a period of time. It is estimated that the cost of setting up MDT functioning in the UK might be more than two to three million pounds for head and neck cancer only. For thyroid cancer MDT the expenses would be mainly the appointment of adequate staff including specialist nurses, MDT coordinators and support staff to allow them to have their MDT meetings and to participate in regular audit and studies . The cost of provision of services, such as the provision of neck lump clinics, recombinant human TSH, and access to PET scans etc., would also be significant.
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