Multidisciplinary case teams: an approach to the future management of advanced colorectal cancer

Bd Minsky

doi:10.1038/bjc.1998.418

Abstract

The effective management of advanced colorectal cancer has traditionally been viewed in terms of treatment outcome measures such as efficacy (survival, objective response and palliation) and safety. Although these outcomes are of paramount importance and are essential for the evaluation of the effectiveness and tolerability of treatment, they do not take account of the global effect of therapy on patients, society and healthcare systems. Furthermore, they may not reveal important differences between treatments of equivalent anti-tumour efficacy that might influence the overall effectiveness in terms of acceptability of therapy. To achieve this, a broader, patient-centred evaluation of advanced cancer treatment is required that acknowledges the views, experience and perspectives of all involved in the treatment process. To this end, the International Working Group in Colorectal Cancer, a multidisciplinary group that encompasses expertise from a range of relevant fields and disciplines, has advocated a multidisciplinary approach to the treatment of advanced colorectal cancer that is likely to deliver the best possible overall care.

Highlights

The assessment of quality of life presents a challenge in cancer care, and there are many factors to be considered, including disease progression, toxicity, inconvenience of some chemotherapy treatment regimens and loss of body function and image associated with a permanent colostomy
Response rate, local control and palliation. These classic outcome measures have been used to assess treatment success in many studies published to date. The value of these end points to the effective management of advanced colorectal cancer (CRC) is indisputable, and they are an integral part of the assessment of treatment outcome
A greater appreciation is being shown of other treatment end points including stabilization of disease, improvements in quality of life, patient satisfaction and convenience of treatments for patients, and the overall cost-effectiveness or cost benefits associated with therapy

Summary

Introduction

The three major types of therapy in colorectal cancer (CRC) are surgery, chemotherapy and radiation therapy, each of which is applied differently depending on whether the aim of treatment is curative or palliative (i.e. to control symptoms and extend survival). The assessment of quality of life presents a challenge in cancer care, and there are many factors to be considered, including disease progression, toxicity, inconvenience of some chemotherapy treatment regimens and loss of body function and image associated with a permanent colostomy.

Results

Conclusion