Multidisciplinary care for advanced disease

Multidisciplinary Care (MDC) for early (curable) malignancy has brought considerable benefit to patient care and outcomes, especially in the area of breast cancer. The application of the principles of MDC to advanced (incurable) malignancy has bee significantly less. However, the NBCC is preparing "Guidelines for MDC for Advanced Disease" (broadly applicable to all cancers), and some centres internationally have developed models of MDC in this setting.

The objectives of MDC in the advanced setting do differ substantially from those for early disease. The focus of care is the prolongation of survival, improvement of quality of life and the supportive care of the patient and their family from the diagnosis of a terminal illness to death, (sometimes of many years duration) whereas in the setting of early disease the major focus of care is cure with appropriate support for recovery and long term survival. The team and processes required for optimum MDC for advanced disease therefore is of significantly different composition, with a focus on the need for repeated reassessment and the significant role of community care providers. However, there are also many similarities including the need for appropriate medical input, good team co-ordination and support.

The design of an effective and efficient MDC model in advanced disease is also challenged by the clear dichotomy of needs in the advanced setting, with the optimization of medical care on the one hand, and the supportive and palliative care needs on the other. Is this achievable? A careful appraisal of the purpose of the MDT in each individual setting must inform the way in which it is designed and coordinated.

Information on several models including the one developed in Eastern Health will be presented. Factors contributing to a successful MDT will be highlighted.