Is there benefit for multidisciplinary care of women with low and high-risk apparent early stage endometrial cancer?

From Cancer Guidelines Wiki

Is there benefit for multidisciplinary care of women with low and high-risk apparent early stage endometrial cancer?

Multidisciplinary care (MDC) can be defined as the coordinated involvement of clinical and allied specialists in the management of a particular patient.[1][2] The aims of MDC[3] are to:

  • ensure that all patients receive timely treatment from appropriate professionals
  • ensure that all relevant input from different specialities is considered in formulating a treatment plan
  • ensure that all clinicians have complete information on the treatment plan, potential problems and prognosis
  • ensure continuity of care
  • ensure that patients get adequate information and support
  • facilitate communication between primary, secondary and tertiary care providers
  • audit and research clinical data
  • monitor adherence to clinical guidelines


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It is recommended that all patients should have access to subspecialist (gynaecological oncologist) care in the management of their gynaecological cancer.

The multidisciplinary team

Multidisciplinary team (MDT) meetings may include input from gynaecological oncologists, medical and radiation oncologists, gynaecological pathologists, palliative care specialists, clinical geneticists, radiologists, trainee medical specialists, nursing and social work personnel, psychologists and research scientists to ensure all aspects of a woman's care, both physical and psychological, are considered.

Multidisciplinary case conference decisions should be carefully documented and communicated to all personnel involved in the woman’s care. The woman’s involvement in decisions is usually via the primary treating clinician, often a gynaecological oncologist. The treatment plan should always consider individual patient circumstances and wishes.

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Multidisciplinary care and clinical outcomes

In the post-operative setting, there may be several options for further treatment available to patients. A multidisciplinary care approach ensures that all suitable options are considered to support best patient outcomes.

No randomised clinical trials have been undertaken to compare clinical outcomes for oncology patients managed by MDTs versus management by individual clinicians[1][4][5] and there are no studies related specifically to endometrial cancer. Two studies from the UK have shown implementation of MDT recommendations in gynaecological oncology and upper GIT and colorectal cancers varies, with between 7% and 15% of recommendations not being followed.[4][5] Similarly, a prospective study of gynaecological cancer cases in the US noted that 84% of recommendations were followed.[6] The authors concluded that the benefit to clinical outcome was actual rather than potential as most recommendations were followed. A retrospective study of 533 cases of ovarian cancer provided evidence that improved survival was associated with management by a MDT.[7] Studies of other tumour sites have shown that MDT management can result in positive patient outcomes, in terms of diagnosis, increase in the proportion of patients staged, treatment planning, survival and patient satisfaction.[4][5][8]

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Multidisciplinary care and psychosocial outcomes

The psychosocial care of a patient begins from the time of initial diagnosis, through treatment, recovery and survival and involves all members of the multidisciplinary team, as well as the patient’s GP, family, friends and carers. Psychosocial care covers physical, emotional, social, and psychological issues, such as self concept, body image and sexuality, as well as interpersonal difficulties, anxiety and fear.[9]

Treatment for endometrial cancer can lead to a number of changes, which can affect a woman's sexuality. Women and their partners require information and education about the effect the cancer and its treatment has on sexual function. A discussion about these aspects of the patient’s care needs to be addressed by the health professionals.[10]

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Other benefits of multidisciplinary care

Studies of MDC have also shown benefits for patients other than clinical outcomes.[3][4] They include:

  • Faster and more coordinated treatment with agreed treatment plans
  • Improved care through best practice and adoption of evidence based guidelines
  • Improved patient satisfaction with treatment
  • More consistent information to patient
  • Entry of eligible patients into trials of new therapies
  • Educational opportunities
  • Mutually supportive environment and reassurance from corporate decision making especially in complex cases
  • Improved well being of members
  • Improved communication between members

A UK survey, conducted between 2000-2004, showed increased patient satisfaction in breast, colorectal and lung cancer care, where MDT is more established.[5] Other reported benefits include improved professional performance (clinically appropriate care) through enhanced clinical expertise and improved coordination of care, resulting in positive effects on patient outcomes.[8]


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Patients may benefit from multidisciplinary team approach at a number of points during their care, including: changes in major treatment modality (surgery, radiotherapy, chemotherapy) post-treatment survivorship care and decisions regarding palliative care.

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Evidence summary and recommendations

Evidence summary Level References
Multidisciplinary care has been shown to improve care in accordance with evidence-based practice and to impact on treatment and management decisions. III-3, IV [4], [5], [6], [8], [11], [12]
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All patients with endometrial cancer should have the benefit of multidisciplinary team management, which includes review of pathology and relevant imaging, and presentation of their case at a multidisciplinary team conference.
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References

  1. 1.0 1.1 Hong NJ, Wright FC, Gagliardi AR, Paszat LF. Examining the potential relationship between multidisciplinary cancer care and patient survival: an international literature review. J Surg Oncol 2010 Aug 1;102(2):125-34 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20648582.
  2. Cancer Australia, Royal Australian and New Zealand College of Obstetricians and Gynaecologists. National Gynaecological Cancers Service delivery and Resource Framework. Cancer Australia. Canberra; 2011.
  3. 3.0 3.1 National Breast and Ovarian Cancer Centre. Multidisciplinary meetings for cancer care: a guide for health service providers. National Breast and Ovarian Cancer Centre: Sydney; 2005.
  4. 4.0 4.1 4.2 4.3 4.4 Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol 2006 Nov;7(11):935-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17081919.
  5. 5.0 5.1 5.2 5.3 5.4 Taylor C, Munro AJ, Glynne-Jones R, Griffith C, Trevatt P, Richards M, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ 2010 Mar 23;340:c951 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20332315.
  6. 6.0 6.1 Petty JK, Vetto JT. Beyond doughnuts: tumor board recommendations influence patient care. J Cancer Educ 2002;17(2):97-100 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12092861.
  7. Junor EJ, Hole DJ, Gillis CR. Management of ovarian cancer: referral to a multidisciplinary team matters. Br J Cancer 1994 Aug;70(2):363-70 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/8054286.
  8. 8.0 8.1 8.2 Bosch M, Faber MJ, Cruijsberg J, Voerman GE, Leatherman S, Grol RP, et al. Review article: Effectiveness of patient care teams and the role of clinical expertise and coordination: a literature review. Med Care Res Rev 2009 Dec;66(6 Suppl):5S-35S Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19692553.
  9. National Breast Cancer Centre, National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. Camperdown, NSW: National Breast Cancer Centre 2003 Jan 1 Abstract available at http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp90.pdf.
  10. Cancer Australia. The psychosexual care of women affected by gynaecological cancers. 2010;Accessed on 05/09/2011 Abstract available at http://modules.cancerlearning.gov.au/psgc/.
  11. Greer HO, Frederick PJ, Falls NM, Tapley EB, Samples KL, Kimball KJ, et al. Impact of a weekly multidisciplinary tumor board conference on the management of women with gynecologic malignancies. Int J Gynecol Cancer 2010 Nov;20(8):1321-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21051971.
  12. Cohen P, Tan AL, Penman A. The multidisciplinary tumor conference in gynecologic oncology--does it alter management? Int J Gynecol Cancer 2009 Dec;19(9):1470-2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19955920.

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Supporting material

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