Multidisciplinary teamwork in urological oncology

Abstract

The cancer pathway, from primary-care referral to specialist consultation, diagnostic test(s), decision to treat, treatment itself and, invariably, life-long follow-up, has the main aim of curing a patient with minimal morbidity, while maintaining their physical and psychological wellbeing. Recently, in the UK it was recommended that improvements in cancer outcome can be achieved through major organizational changes in cancer care by reorganizing cancer services into ‘cancer networks’ and adopting significant changes in professional practice through the promotion of specialization by individual consultants, a multidisciplinary approach and shared clinical protocols [101]. In urological oncology, it was recommended that all cancer patients should be managed by a multidisciplinary urological cancer team [102]. Taking this mandate forward, patterns of clinical practice have changed and at the heart of modern urological cancer care is the multidisciplinary team (MDT). The MDT consists of: • Consultant urologists; • Clinical and medical oncologists; • Radiologists with expertise in urological cancers to perform imaging investigations in accordance with the Royal College of Radiologists’ Guidelines [1]; • A specialist uropathologist who reports on all the information required by the current Royal College of Pathologists’ minimum dataset for the relevant cancer [103]; • Clinical nurse specialists who have a high level of skill in communication. Patient advocacy and provision of information and support for patients and carers are crucial aspects of this role; • An MDT coordinator, who organizes the weekly meeting and ensures that all required documentation is available at each meeting (e.g., patient lists and case notes); • A designated lead clinician (normally a consultant urologist) who will take overall responsibility for the service. According to the Guidance on Cancer Services: Improving Outcomes in Urological Cancers paper, the main roles of the MDT are: Provision of a rapid diagnostic and assessment service, including satisfying the 2-week-wait criterion [104];