Experiences with a pilot electronic skin multidisciplinary clinic for complex skin cancer

Abstract

Introduction: Complex skin cancers (CSCs) may benefit from review by a specialist skin multidisciplinary team (MDT). Accessing an MDT may be difficult for practitioners in non-metropolitan settings. Technology has been promoted as a solution. We decided to pilot an electronic or virtual skin MDT (eMDT). Methods: To gauge the level of need for a skin cancer MDT, a survey was circulated at a rural general practitioners (GPs) conference. Previous non-metropolitan referrers of skin cancer patients to our centres were also contacted to acertain the level of need, and a search was conducted for other non-metropolitan doctors who may be interested. For the skin cancer cases that were discussed at the eMDT, patient characteristics’ data was collected and included sex, age, distance from the patient’s home to our hospital, referral information, whether the patient was immuno-suppressed, whether the diagnosis involved a true CSC, what the referrer’s question was for the MDT, and whether a decision was made to advise the referring clinician of the MDT specialist team’s recommendations. Results: Five rural general practitioners (GPs) who responded to a survey, 10 previous referrers and 5 other rural GPs unanimously supported the need for a skin eMDT service. The surveys revealed that on average patients waited five months and travelled approximately 140 kilometres (km) to access specialist treatment. Four out of five (80%) of the survey respondents did not have an established referral pathway for CSC cases. Seven eMDT meetings were held fortnightly over 13 weeks. A total of 19 patients were presented. Of these, two patients were presented twice. Eighteen of the 19 patients were referred directly from members of the eMDT specialist team with radiation oncologists (ROs) accounting for most of the referrals (11/19). Only one referral came from a rurally based GP. The average age of the 19 patients was 69 years (range: 33-62 years), and 12 patients were males. The average distance from the patients’ home to our hospital was 75 kilometres. Six patients had an ECOG performance status of one or more. Five were immunocompromised, and all were reasonable cases to present. Eighteen patients had clear documented treatment decisions made by the eMDT with most decisions being for either adjuvant or definitive radiotherapy. Discussion: The structure and function of the eMDT is detailed along with the involvement of regional GPs. There could have been some bias observed because the number of ROs who participated outweighed that of other specialists. The eMDT was phased out for several reasons. It failed to serve the target referrer and patient population; process and documentation were poor; and there were issues with perceived competition from within and outside our health area. The arrival of the Covid-19 pandemic meant that our hospital’s main skin MDT became a virtual meeting, and the eMDT was therefore amalgamated into this service.