The National Institute of Clinical Excellence published an "improvement in outcomes" guidance for head and neck cancer in November 2004. This is a most comprehensive assessment of the service and will provide detailed and definitive advice about service configuration and commissioning of cancer services for thyroid cancer as well. The following is a summary. For the details the reader is advised to consult the manual  or the website -www.nice.org.uk.
The responsibility of the thyroid MDT would be to provide a service usually for a population base of over 1 million and generally should be established in a cancer center or involve several cancer units.
Thyroid cancer MDT can either be part of a currently existing head and neck cancer team or operate as a separate endocrine oncology team who discuss predominantly malignant but also benign thyroid conditions.
The MDT should be responsible for the diagnosis, assessment, decisions about treatment and overall management of patients throughout the course of the disease and also provide support.
The MDT should decide what would be the most appropriate treatment for individual patients and where and by whom it should be carried out.
Teams should be responsible for providing the highest quality of care promptly and efficiently and provide information to patients, their primary care physicians, and all professionals concerned.
The MDT should also support, advise, and educate professionals who provide services for these patients outside of the cancer center and therefore may have to provide an outreach service.
The MDT should make arrangements for referral at each stage of the patient's treatment, which should be streamlined.
A named member of the core team should be the principal clinician to whom the patient should relate at one particular time.
MDT coordinators should organize a meeting at a specific time and on a regular basis.
Audit would be a central feature regarding clinical outcomes, and patient and carer surveys should also be carried out.
The MDT should also take responsibility for making sure that comprehensive data collection takes place regarding the patient's stage, treatment decision, and outcomes, and that regular audits are undertaken.
There have been a lot of publications about a positive volume and outcome relationship, particularly in oncology, and it would appear that outcome is likely to be better in centers with a larger volume of work in thyroid cancer surgery and management than in centers that see only a few patients a year, as already indicated earlier in this chapter. In the long term, it is likely that surgery will be centralized so that it is done by specialized surgeons.
Also more reliable and meaningful audits or studies can be carried out and skills can be maintained and improved in rare cancers like thyroid cancer if large numbers are concentrated in a center and treated by a small number of experts .
These measures will lead to the provision of uniform and high quality care across the country.
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