In response to this report released by Cancer Research UK yesterday, Fiona MacNeill, President of the Association of Breast Surgery said, "There is growing concern amongst breast care teams about the increasingly cumbersome and bureaucratic nature of the weekly breast team meetings. Such meetings are an invaluable part of patient care and support good team working and training, but it is clear that they need to be refined to ensure sustainable, high quality patient care through more focused use of resources and manpower. This was a major topic of discussion at the recent UK Breast Cancer Group (UKBCG) meeting in November 2016, and the Cancer Research UK report is a timely stimulus and mandate for change. Both the ABS and UKBCG will work together over the next few months to provide new models of working.”
Multidisciplinary Team Meetings are under growing pressure
The increasing number of patients being discussed at expert cancer meetings means that specialists are under growing pressure, according to a Cancer Research UK report published yesterday.
In 2014/15, 1.4 million discussions about cancer patients took place at Multi Disciplinary Team (MDT) meetings across the UK. This has increased by 20 per cent each year since 2011.
The researchers received more than 3,550 responses from healthcare professionals on a survey asking their experiences of MDT meetings and how they can be improved. The team covered 624 patient discussions at 24 meetings and visited 10 locations.
They found that individual patients were discussed for an average of three minutes and more than half of patients were discussed for two minutes or less in meetings that can last for several hours.
The meetings are typically made up of a variety of healthcare professionals including cancer consultants, clinical nurse specialists, advanced nurse practitioners, research nurses, consultant radiologists, consultant histopathologists and an MDT coordinator.
But on average only three experts contributed to each discussion and at times this was as few as one or two experts. In some cases, discussions about the best treatment option for a patient had to be delayed to the next meeting if the right information was not available or the right experts were not there.
The cancer strategy for England called MDT meetings the ‘gold standard’ of cancer services, bringing together a range of experts to advise on the best treatment options, ensuring high quality care for all patients. But the Cancer Research UK report shows that to reflect the changing nature of care and the increased demand for services, the meeting format must be refreshed to ensure they work more effectively.
The report recommends that national guidelines on which experts should attend MDT meetings needs to change as not all those attending the meetings need to be there for the duration and to make sure the right expertise is represented.
The report also recommends that patients whose treatment plan is more straightforward and which can be based on agreed protocols may not need to wait for an MDT discussion. Instead, their cases could be reviewed outside the full MDT meeting by a smaller group of experts allowing more time at the full meeting to discuss patients with more complicated cases. The report also makes recommendations to ensure the right information about the patient being discussed is available for each meeting.
This research comes at a time when medical staff across the UK are struggling to cope with the increasing number of patients being diagnosed with cancer. Previous Cancer Research UK reports have shown that patients are also experiencing delays in cancer tests, examinations and results.
Emma Greenwood, Cancer Research UK’s director of policy, said: “We know that these meetings are essential to provide the best possible care for patients. But this research shows the need for change to ensure the meetings make the best use of our specialists’ time while making sure patients continue to get the best treatment.
“The number of healthcare professionals willing to get involved in this work shows how important it is to the staff. And we know there’s increasing pressure on the cancer workforce to keep up with the rising patient numbers, with a number of key specialities urgently needing increases in staff. It’s really important that the health service in each UK nation takes these recommendations on board to make these meetings more time and cost effective.”
Professor Arnie Purushotham, Cancer Research UK’s senior clinical adviser, said: “Patients are our priority and these MDT meetings give a fantastic opportunity to bring expertise from across the board to recommend the best treatment for our patients. However, this report importantly highlights the need to refresh these meetings. We need to accept these recommendations and support health care professionals to do the best job on behalf of cancer patients.”