Abbasi, Ahmed Nadeem

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eCommons@AKU

eCommons@AKUDepartment of Radiation Oncology Medical College, PakistanNovember 2016Establishment of site specific multi disciplinarytumour boards in Pakistan -Is it really necessary todiscuss all cancer cases in multidisciplinary tumourboard meetings?Ahmed 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 of site specific multi disciplinary tumour boards in Pakistan -Is it really necessary to discuss allcancer cases in multidisciplinary tumour board meetings?. Journal of Pakistan Medical Association, 66(11), 1355-1356.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiat_oncol/39In Pakistan, we are witnessing an initial phase ofestablishment of site specific Multidisciplinary TumourBoards. We are still going through the teethingproblems which are bound to occur in a country wherethe concepts of patient centeredness are not yet verywell understood by practicing clinicians.Site Specific Multi-disciplinary teams take theownership of MDT Tumour Boards in which all radicalcancer cases belonging to a certain site, are presentedand discussed. A consensus opinion is being reachedafter this panel discussion.The Multidisciplinary Tumour Board (MDT) meetings,sometimes also referred to as multidisciplinary tumourconferences, or multidisciplinary tumour boards, areconducted to involve clinicians from all concernedspecialties to discuss diagnostic and treatment optionsfor patients diagnosed with cancer.1 This improvespatient outcome, since it is a well recognized fact thatcancer management is not a single person's job.1 Whilea number of studies have concluded that thesemeetings significantly contribute to the bettertreatment outcomes for patients,2-4 an importantquestion that needs to be addressed is whether it isreally necessary to discuss all cancer patients in MDTmeetings before embarking on the first management,considering the increased prevalence of cancers all overthe world and the increasing time required to discussrelevant tumour cases in these meetings.5MDT meetings have played an important role inincreasing the number of case presentations atoncology conferences which reached an all-time high. Astudy conducted at a USA hospital (Central Dupage,Winfield) lung cases were presented at 149% ofprevious annual levels. Of the annual caseload 15% ofthe uterine cases were presented; before the advent ofthe multidisciplinary clinics, this rate was 0%.6 MDTmeetings have been shown to enhance graduatemedical education by providing a unique experiencenot seen in the typical residency and fellowship.6Patients identified by tumour boards are 2.5 times morelikely to be part of a clinical trial than other patients.7As mentioned in the first few lines, we are still trying toembrace the idea of development of thisMultidisciplinary culture in our country. Personalattitudes play the most pivotal and strongest role in theestablishment of these boards in academic instituteswhere specialists are practicing under one roof. As onecan imagine, the task becomes more difficult in centerswhere comprehensive care is not available. City TumourBoard is one unique example of an independentmultidisciplinary tumour board which is a fortnightlyevent organized by specialist colleagues on alternateSunday mornings starting at 08:00 am. Before theestablishment of this City Tumour Board it wasunimaginable for senior academic leads of differentspecialties to even gather on Sunday mornings for evenpaid assignments. The success of this board tells us a lotabout selfless cancer carers who can devote their timeeven on a Sunday early morning for the sake of theircancer patients without thinking about any monetaryor other gains. It would be a worthwhile reading formedical students and practicing clinicians to gothrough recent updates on City Tumour Board whichwas published in Journal of Pakistan MedicalAssociation (JPMA) in December 2013 issue.8 In Pakistanwe have certain administrative and managerial gaps inour Healthcare Services. In my humble opinion, insteadof waiting for their correction and or wasting ourvaluable quality time in futile discussions, we can worktogether, and establish quality multidisciplinary teams.Weekly site specific Tumour Boards can be achieved viathese teams. In American Society of Clinical Oncology2014 meeting a commentary is being made mentioningthe role of Tumour Boards in service settings whereresources are limited. Authors from Lebanon, Harvard,USA and Sussex University, United Kingdom aresuggesting that tumour boards may help overcomethese limitations.9J Pak Med Assoc1355EDITORIALEstablishment of site specific multi disciplinary tumour boards in Pakistan— Isit really necessary to discuss all cancer cases in multidisciplinary tumour boardmeetings?Ahmed Nadeem AbbasiDepartment of Oncology, Aga Khan University, Karachi, Pakistan.Correspondence: Email: nadeem.abbasi@aku.eduInstead of wasting further valuable time, we can takethe advantage of published literature which is definitelyfavouring site specific MDT Tumour boards and embarkon it's establishment. To summarize, MDT meetings playa very important role in better treatment of the cancerpatients in significant number of cases at varioustumour sites because members from differentspecialties augment different interpretations. Cancertreatment is a team work and all disciplines involved inpatient centered care appreciate an opportunity ofdeliberations before starting treatment. Thepathologist-radiologist correlation helps in bettertumour staging whereas surgeon-oncologistcorrelation results in improved treatment plan.Discussing increased number of cases with moreregular attendance improves the outcome of thesemeetings. It is therefore recommended that all tumourcases be discussed in MDT meetings regardless of site,staging and grading. It will also play a beneficial role inimproving academics and research work.We are hoping to see establishment of Multi-Disciplinary Tumour Boards in all institutes of Pakistanwhere cancer care is being provided.10References1. Abdulrahman Jnr GO. The effect of multidisciplinary team care oncancer management. Pan Afr Med J 2011; 9: 202. Croke JM, El-Sayed S, MD, Multidisciplinary management ofcancer patients: chasing a shadow or real value? An overview ofthe literature. Curr Oncol 2012; 19: e232-8.3. El Saghir NS, El-Asmar N, Hajj C, Eid T, Khatib S, Bounedjar A, et al.Survey of utilization of multidisciplinary management tumorboards in Arab countries. Breast 2011; 20 Suppl 2: S70-4.4. Lamb BW, Sevdalis N, Taylor C, Vincent C, Green JS.Multidisciplinary team working across different tumor types:analysis of a national survey. Ann Oncol 2012; 23: 1293-300.5. Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N, etal. Quality of care management decisions by multidisciplinarycancer teams: a systematic review. Ann Surg Oncol 2011; 18:2116-25.6. Horvath LE, Yordan E, Malhotra D, Leyva I, Bortel K, Schalk D, et al.Multidisciplinary Care in the Oncology Setting: HistoricalPerspective and Data from Lung and GynecologyMultidisciplinary Clinics. J Oncol Pract 2010; 6: e21-6.7. Kuroki L, Stuckey A, Hirway P, Raker CA, Bandera CA, DiSilvestroPA, et al. Addressing clinical trials: can the multidisciplinaryTumor Board improve participation? A study from an academicwomen's cancer program. Gynecol Oncol 2010; 116: 295-3008. Asghar AH, Abbasi AN, Jamal A, Haider G, Rizvi S. J.City tumourboard Karachi: an innovative step in multidisciplinary consensusmeeting and its two years audit. Pak Med Assoc 2013; 63: 1534-59. El Saghir NS, Keating NL, Carlson RW, Khoury KE, Fallowfield L.Tumor boards: optimizing the structure and improving efficiencyof multidisciplinary management of patients with cancerworldwide. Am Soc Clin Oncol Educ Book 2014: e461-6.10. Abbasi AN. Cancer management is a multidisciplinary teamwork.J Coll Physicians Surg Pak 2011; 21: 259-61.Vol. 66, No. 11, November 2016Establishment of site specific multi disciplinary tumour boards in Pakistan — Is it really necessary to discuss... 1356

Establishment of site specific multi disciplinary tumour boards in Pakistan -Is it really necessary to discuss all cancer cases in multidisciplinary tumour board meetings?

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Establishment of site specific multi disciplinary tumour boards in Pakistan -Is it really necessary to discuss all cancer cases in multidisciplinary tumour board meetings?

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