Abbasi, Ahmed Nadeem

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eCommons@AKUDepartment of Radiation Oncology Medical College, PakistanOctober 2016Establishment and maintenance of quality of site-specific multidisciplinary tumor boards in PakistanAhmed Nadeem AbbasiAga Khan University, nadeem.abbasi@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiat_oncolPart of the Oncology Commons, and the Radiology CommonsRecommended CitationAbbasi, A. N. (2016). Establishment and maintenance of quality of site-specific multidisciplinary tumor boards in Pakistan. Journal ofthe College of Physicians and Surgeons Pakistan, 26(10), 805-807.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiat_oncol/38Establishment of site-specific multidisciplinary tumorboards is being taken up as a healthcare goal byinstitutes providing cancer care in Pakistan and othercountries of the SAARC region. Over a period of time,the real benefits of these tumor boards have beenwitnessed in terms of better quality care of cancerpatients. In the western countries, like the United Kingdom,these multidisciplinary meetings are mandatory eventsand they have already gone through the establishmentphase of this important patient-centred activity. We,practising in LMI (Low and Medium Income) countries,are still embracing this idea and are a bit slow inadopting this change. Most of the time, it is the lack ofclinicians’ time being used as a primary excuse quotedin defence of inexistence of these site-specific boards.This is high time that those who are committed toprovide best quality healthcare to their cancer patientswould satisfy the global standards and quality bench-marks. Peer reviewed practices were being adapted asstandard of care; and site-specific multidisciplinarytumor boards are an important integral component of acomprehensive patient-centred care plan.The question of mandatory inclusion of all cases fordiscussion in these proposed site-specific tumor boardsis not answered yet. In the atmosphere of present-dayclinical practice, this notion of mandatory inclusion of allcancer cases sounds like an impossible task. Therefore,realising the ground reality situation and backgroundpractical scene, reluctantly, one can think about makinga selection of relevant cases for discussion in thesetumor boards. From a perfectionist's perspective, theideal wish is to bring a cultural change in our healthcaresystem in a day via a magic wand. Unfortunately, thereality is that, the clinicians are not in any authoritativeposition to implement this change which will turn roundthe local cancer care practice by 180 degrees.Therefore, staying in the real world, what can besuggested is a team-building approach to proceed withone step at a time; and on voluntary basis, startestablishing these tumor boards in our institutions. Thisrequires a core backup of colleagues who wish to bringtheir cases for discussion, seeking consensus opinionwith multidisciplinary expert input.The whole question of quality of these tumor boardsneeds to be addressed as well. Fortunately, there arehealthcare institutions in the country which are taking thepains for getting certifications and accreditations ofquality health systems via independent third partyauditors like JCIA (Joint Commission for InternationalAccreditation), I.S.O., etc. It is expected to see fastersteps in this ongoing uphill course in institutes acrossthe region. National Health Service (NHS) of the UnitedKingdom had setup an example of introduction and firmestablishment of site-specific multidisciplinary teamsand regular mandatory multidisciplinary meetings whichare named as tumor boards in North America and also inmost of the developing countries, like Pakistan.In all fairness to our cancer patients, it will be a blessingfor them if we spare time from our busy clinicalcommitments and devote it to organise these tumorboards for a thorough review and discussion of theircases. One may not be able to discuss all the cases inthe early phase of inception of these boards; but,hopefully after going through the strengthening phase,selection criteria can be drawn to be adopted andimplemented by the coordinator(s) of such boards.Adding up ancillary services and allied healthcaregroups in these boards would be considered as asecondary step. One can follow the example ofmultidisciplinary core membership from the lists given inUnited States-based National Comprehensive CancerNetwork (NCCN) Guidelines. In our JCIA-accreditedtertiary level healthcare related university, some site-specific multidisciplinary teams (MDT) have beenformed which are conducting tumor boards on a regularbasis covering site-specific areas like breast, head andneck, gynaecology, orthopaedics, neurology, gastro-enterology, urology, thyroid, and haematology. On thepaediatric side, separate tumor boards are beingconducted for paediatric solid tumors, haematologicalmalignancies, and tumors of central nervous system.These boards attract participation from almost allinstitutions of the city. Paediatric boards are beingconducted in joint collaboration with the Children CancerHospital; and for CNS tumors, the board is videolinkedwith Sick Kids Hospital, Toronto, Canada. AnotherJournal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (10): 805-807 805EDITORIALEstablishment and Maintenance of Quality ofSite-Specific Multidisciplinary Tumor Boards in Pakistan Ahmed Nadeem AbbasiDepartment of Oncology, The Aga Khan University Hospital,Karachi.Correspondence: Dr. Ahmed Nadeem Abbasi, Associate Professorand Section Head, Radiation Oncology, Department of Oncology,The Aga Khan University Hospital, Karachi.E-mail: nadeem.abbasi@aku.edu Received: September 23, 2016;   Accepted: October 07, 2016.unique example is of City Tumor Board in Karachi whichis a regular fortnightly event, regularly going on for thelast 6 years. There are many relevant lessons which wecan learn from our colleagues who have gone throughthe process of establishment of these boards. Forexample, studies are being conducted in the UnitedKingdom which are trying to explore the processes ofdecision-making employed in these multidisciplinarymeetings.1 MDT meetings have played an important rolein increasing the number of case presentations atoncology conferences which reached to an all-time high.A study conducted at the Central DuPage Hospital,Winfield, USA, shows lung cases were presented at149% of previous annual levels. Of the annual caseload, 15% of the uterine cases were presented; beforethe advent of the multidisciplinary clinics, this rate was0%.2 MDT meetings have been shown to enhancegraduate medical education by providing a uniqueexperience not seen in the typical residency andfellowship training.2 Patients identified by tumor boardsare 2.5 times more, likely to be part of a clinical trial thanother patients.3As mentioned earlier, we are still trying to embrace theidea of development of this multidisciplinary culture inPakistan. Personal attitudes play the most pivotal andstrongest role in the establishment of these boards inacademic institutes where specialists are practicingunder one roof. As one can imagine, the task becomesmore difficult in centres where comprehensive care isnot available. Before the establishment of the earliermentioned City Tumor Board, it was unimaginable forsenior academic leads of different specialities to gatheron Sunday mornings for even paid assignments. Thesuccess of this Board tells us a lot about selfless cancercarers who can devote their time even on a Sundayearly morning for the sake of their cancer patientswithout thinking about any monetary or other gains. Itwould be a worthwhile reading for medical students andpracticing clinicians to go through the updates on CityTumor Board.4 In Pakistan, there are administrative andmanagerial gaps in healthcare services. In my humbleopinion, instead of waiting for their correction and orwasting our valuable quality time in futile discussions,we can work together for the establishment of qualitymultidisciplinary teams. Weekly site-specific tumorboards can be achieved via these teams.In the American Society of Clinical Oncology 2014meeting, a commentary mentioned the role of tumorboards in service settings where resources are limited.Authors from Lebanon, Harvard (USA) and SussexUniversity (United Kingdom) suggested that tumorboards may help overcome these limitations. As Saghiret al. quoted, there are multiple benefits of these boards.A good number of treating clinicians put their trusts indecisions made by specialists teams at the tumorboards. These site-specific multidisciplinary boards areregarded by many doctors as a form of second opinionbased on a team's efforts in which cases are beingreviewed thoroughly and evidence-based recommendationsare being made by consensus of experts.5To summarise, MDT meetings play a very important rolein better treatment of the cancer patients in significantnumber of cases at various tumor sites becausemembers from different specialities augment eachothers’ interpretations. The pathologist-radiologistcorrelation helps in better tumor staging, whereassurgeon-oncologist correlation results in improvedtreatment plan. Discussing increased number of caseswith more attendance, improves the outcome of thesemeetings. It is, therefore, recommended that all tumorcases be discussed in MDT meetings regardless of site,staging and grading. It will also play a beneficial role inimproving academics and research works. We arehoping to see establishment of multidisciplinary tumorboards in all institutes of Pakistan, where cancer care isbeing provided.6 As the time is passing, more evidenceis being gathered and published in contemporaryliterature supporting the need of site-specific tumorboards.7A recently published systemic review clearly states thebenefits of boards in terms of professional growth ofhealthcare providers.8 In all the tertiary referral cancerinstitutions of Pakistan, early work of initiation of thesesite-specific multidisciplinary tumour boards is beingstarted. Although the initiation phase seems to beprogressing slowly, but we are witnessing a positivechange of attitudes of treating physicians towards morepatient-centred discussions among each other. In manyhigh-volume institutes in Karachi, Lahore, Rawalpindi,Islamabad, Peshawar and Quetta, more and more site-specific boards are being conducted. In the peripheralcities of Pakistan, institutes are trying to establish thesesite-specific boards. In most of these centres in someform or other, general tumour boards are beingconducted. We are spearheading this concept ofdeveloping MDT culture in the region, which willdefinitely improve our quality of healthcare.9REFERENCES1. Soukup T, Petrides KV, Lamb BW, Sarkar S, Arora S, Shah S,et al. The anatomy of clinical decision-making in multidisciplinarycancer meetings: A cross-sectional observational study ofteams in a natural context. Medicine (Baltimore) 2016; 95:e3885.2. Horvath LE, Yordan E, Malhotra D, Leyva I, Bortel RNK, SchalkAPND, et al. Multidisciplinary care in the oncology setting:historical perspective and data from lung and gynecologymultidisciplinary clinics. J Oncol Pract 2010; 6:e21-e26. 3. Kuroki L, Stuckey A, Hirway P, Raker CA, Bandera CA,DiSilvestro PA, et al. Addressing clinical trials: Can themultidisciplinary tumor board improve participation? A studyfrom an academic women's cancer program. Gynecol Oncol2010; 116:295-300. Ahmed Nadeem Abbasi806 Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (10): 805-8074. Asghar AH, Abbasi AN, Jamal A, Haider G, Rizvi S. City tumourboard Karachi: An innovative step in multidisciplinaryconsensus meeting and its two years audit. J Pak Med Assoc2013; 63:1534-5. 5. El Saghir NS, Keating NL, Carlson RW, Khoury KE, Fallowfield L.Tumor boards: Optimizing the structure and improvingefficiency of multidisciplinary management of patientswith cancer worldwide. Am Soc Clin Oncol Educ Book 2014:e461-6. 6. Abbasi AN, Cancer management is a multidisciplinary teamwork. J Coll Physicians Surg Pak 2011; 21:259-61.7. Lamb BW, Jalil RT, Sevdalis N, Vincent C, Green JS. Strategiesto improve the efficiency and utility of multidisciplinary teammeetings in urology cancer care: A survey study. BMC HealthServ Res 2014; 8:377. 8. Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, BowdenP, et al. The impact of multidisciplinary team meetings onpatient assessment, management and outcomes in oncologysettings: A systematic review of the literature. Cancer TreatRev 2016; 42:56-72.9. Abbasi AN, Karim MU, Ali N, Hafiz A, Qureshi BM. Multi-disciplinary team tumour boards are a lifeline for our cancerpatients in lower and middle income countries. Clin Oncol(R Coll Radiol) 2016; 24:30181-9.Establishment and maintenance of quality of site-specific multidisciplinary tumor boards in PakistanJournal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (10): 805-807 807

Establishment and maintenance of quality of site-specific multidisciplinary tumor boards in Pakistan

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Establishment and maintenance of quality of site-specific multidisciplinary tumor boards in Pakistan

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