Multidisciplinary clinical approach to the management of head and neck cancer

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Within the practice of cancer care over the past two decades, there has been a continual and rapidly expanding range of potentially efficacious treatment options, which introduce therapeutic dilemmas about optimum management plans and how these should be presented to patients [1]. This increased specialisation and complexity of knowledge has led to the introduction of multidisciplinary teams (MDTs) for the management of patients with cancer [2]. In the past, treatment for all but a few patients with cancer was based on decisions that were made unilaterally, without necessarily following an evidence-based approach [3]. One of the aims of cancer management by a multidisciplinary team hopes to ensure that all patients will benefit from the wisdom of a variety of specialist team members who can share their expertise, professional perspective, and knowledge [1, 3, 4] and has become the model of care in many countries [5]. The introduction of MDTs in England was given impetus by the production of tumour-specific guidance (Improved Outcomes Guidance; IOG), which aimed to standardise and improve the outcomes of cancer care [6]. The benefits of MDT working are thought to include improved communication, coordination, and decision-making between health care team members when weighing up treatment options. Indeed, multidisciplinary discussion can help health care professionals to tailor holistic treatment plans to patients’ tumour types, biological markers as well as their comorbidities and social circumstances [7]. Evidence has been provided that multidisciplinary team-working can make a positive impact on the quality of clinical decision-making, clinical outcomes for patients, patients’ experience of care and also the impact on the working lives of team members [8]. The introduction of MDT practice for cancer management was originally introduced to counter apparent shortfalls in cancer care provision in the UK in the mid-1990s and aimed to ensure all patients achieved prompt access to expert advice, up-to-date treatments, provided by relevant professionals with specialist knowledge and skills [6]. An additional aspiration was to ensure seamless specialist continuity of care for all patients, as well as the offer of adequate information and support. There is almost universal approval for this strategy [9], which indeed some considers crucial [10], despite the fact that there is little evidence of its effectiveness in improving outcomes [11]. A large survey [5] of MDT members in the UK in 2009, and included 109 from the Head and Neck Service, enabled a set of recommendations to be formulated to define how an effective MDT would work (http://www.ncat.nhs.uk). In summary, the analysis of the survey reveals a strong consensus between MDT members from different tumour types, while also identifying areas that require a more tailored approach, such as the clinical decision-making process, and preparation for and organisation of MDT meetings [5]. In addition, in a systematic review on factors that affect the quality of clinical decision-making of MDTs, several factors have been identified: inclusion of time to prepare for MDTs into team-members’ job plans, making teams and leadership skills training available to team-members, and systematic input from nursing personnel would address some of the current shortcomings [7, 12]. The management of patients with head and neck cancer is considered complex and requires a multifaceted treatment strategies for a heterogeneous group of tumours P. J. Bradley (&) Emeritus Consultant ORL-HNS, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham NG7 2UH, UK e-mail: pjbradley@zoo.co.uk