Abbasi, Ahmed Nadeem

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eCommons@AKUDepartment of Radiation Oncology Medical College, PakistanMay 2011Cancer management is a multidisciplinary teamworkAhmed Nadeem AbbasiAga Khan University, nadeem.abbasi@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiat_oncolPart of the Neoplasms CommonsRecommended CitationAbbasi, A. N. (2011). Cancer management is a multidisciplinary team work. Journal of the College of Physicians and Surgeons Pakistan,21(5), 259-261.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiat_oncol/59Journal of the College of Physicians and Surgeons Pakistan  2011, Vol. 21 (5): 259-261 259Cancer incidence is rising across the world. Up-to-datestatistics on cancer occurrence and outcome areessential for the planning and evaluation of programmesfor cancer control. In Pakistan we do not have a NationalCancer Registry. Data is being published on the SouthKarachi cancer cases. The age-standardized rates(ASR) for cancer (whole body sites), during 1995 to1997 in Karachi South were 139.11/100,000 in malesand 169.5/100,000 in females. Corresponding rates forthe period 1998 to 2002 were 179.0/100,000 in malesand 204.1/100,000 in females. In the 1995-1997 data,the most common malignancies (ASR per 100,000) inmales were lung (21.3), oral cavity (14.2), urinarybladder (9.0), and larynx (8.8). The most frequentcancers in females were breast (53.1%), oral cavity(14.5%), and ovary (10.9%). The data from 1998 to2002 showed a rising incidence for lung (25.5%), larynx(11.8%), and urinary bladder (9.9%) in males and breast(69.1%), esophagus (8.6%), and cervix (8.6%) infemales. The mean age of cancer all sites was 51.2years (95% CI 49.4-53.1) for males; 50.0 years (95% CI48.2-52.4) for females in 1995-1997. Correspondingrates for 1998-2002 were 49.5 years (95%CI 47.5-51.4)in males and 53.7 years (95% CI 51.5-55.6) in females.1Some institutions are now starting to develop their ownCancer Registry.The global cancer incidence estimate by the GLOBOCAN2002 was 8.7% (men 13.3%; women 3.4%) under-estimated due to under-ascertainment in elderly cases.This means that worldwide, new cancer cases in 2002were 11,810,000 (6,574,000 men; 5,236,000 women),overtaking the original estimate by 1 million.2The crude annual incidence of cancer in Europe hasbeen estimated at 338 per 100,000 population forEastern Europe and 447 per 100,000 population inWestern Europe.3 Each year more than 284,000 peopleare diagnosed with cancer (excluding non-melanomaskin cancer) in the UK, and more than 1 in 3 people willdevelop some form of cancer during their lifetime.4In Europe, the relevant information for 2008 is notgenerally available as yet, therefore, statistical modelsbased on published data were used to estimateincidence and mortality data for 25 cancers in 40European countries (grouped and individually) in 2008.If not collected, national rates were estimated fromnational mortality data and incidence and mortality dataprovided by local cancer registries of the same orneighbouring country. There were an estimated 3.2million new cases of cancer and 1.7 million deaths fromcancer in 2008.5Despite the lack of a Registry and population-baseddata on demographics and characteristics of variouscancers, this fact is being observed by practicingclinicians that now they are diagnosing moremalignancies in their clinics than ever before. One of thetypical prototype example is squamous cell carcinomaof the head and neck region which is found to beassociated with the use of tobacco in the form of beetleleaf, beetle nuts, various forms of chewing tobaccos,gutkas and a combination of some or all of these harmfulsubstances.As rising cancer incidence is a global issue, and somecancers are preventable, health policy makers in certaincountries took the issue as a national priority. Countrieslike USA, UK, France, and others had made theirNational Cancer Plans, and they are in the process ofimplementing their goals and objectives.We in Pakistan are still struggling to develop thesestrategies. Being a developing country we cannot affordto provide state-of-the-art treatment facilities to thepatients. The overall expenses of cancer managementare huge and lack of resources is a major factor, whichplays a vitally important role in the poor outcome of thisdisease in our country. Patients present late, and by thetime their tumours are diagnosed, they can only beconsidered for palliative treatment.With the above mentioned suboptimal starting point,there is another issue of treatment. Other countries ofthe world had learnt the hard lessons and now they haverealized that cancer management is not a one manshow. It is of the highest importance and relevance toinvolve key stake holders in the form of all concernedspecialties before embarking on a comprehensivemanagement plan for a particular patient. Working in aworld where the working week and the availablequalified staff are both shrinking, a continuous provisionof good quality care and clinical services is only possiblewith multidisciplinary team work. Department of Radiation Oncology, The Aga Khan UniversityHospital, Karachi.Correspondence: Dr. Ahmed Nadeem Abbasi, Head ofDepartment of Radiation Oncology, Ibn Zuhr Building, The AgaKhan University Hospital, Stadium Road, P. O. Box. 3500,Karachi-74800.E-mail: nadeem.abbasi@aku.eduReceived  October 26, 2010; accepted  March 4, 2011.Cancer Management is a Multidisciplinary Team WorkAhmed Nadeem AbbasiEDITORIALBeing looked after by a multidisciplinary team, thepatient’s faith and confidence increases markedly justas an assurance of not being treated by a singleclinician.The UK Cancer Plan set out the first comprehensivenational cancer programme for England. It had fouraims, which were centered around tackling healthinequalities in order to get down the death toll of theunskilled workers, who were twice as likely to die ofcancer as compared to the professionals. They investedinto strong cancer research and genetics, to save morelives, ensuring provision of the best available support,care and treatment to all the cancer patients. This planprovided a strategy for bringing together prevention,screening, diagnosis, treatment and care for cancer andthe investment needed to deliver these services in termsof improved staffing, equipment, drugs, treatments andinformation systems.6There is a growing tendency amongst members of theoncology community to form Expert Panel MultiDisciplinary Tumour Boards and to discuss all cases inthis panel before offering the treatment to the patient.As this is a recommended international approach,specialists are quite willing to adopt this culture ofsharing ideas with their colleagues. An evidence ofmultidisciplinary approaches providing optimal treatmentoutcome for locally advanced head and neck cancer,with overall survival in these patients being comparableto that reported in randomized clinical trials wasreported by Nguyen et al. in their retrospective analysisof 213 patients treated for locally advanced head andneck cancer in a single institution.7 This effective clinicalapproach will provide opportunities to individualmembers of the team to speak directly to each otherabout clinical matters, discussing the often forgottenclinical management protocols, thus enhancing theirquality of care and outcome.Unfortunately, no institute so far, has made arrangementto discuss all newly diagnosed cancer patients in theirTumour Boards. In my opinion, no cancer patient shouldbe treated without making a comprehensive manage-ment plan which has to be agreed upon by consensus inan Expert Panel Multi-Disciplinary Tumour Board. Thecore constituents of a Tumour Board are Oncologists,Surgeons, Radiologists, Pathologists and Physicians.Other members from the support services can alsoparticipate e.g. Nutritionists, etc. Postgraduate traineedoctors can learn and develop valuable clinical skillswhile attending the Boards. This is an easy access toknowledge, where case discussions lead to a crossfertilisation of ideas that may not have been apparent toa single treating clinician. Team working increases thesense of partnership and provides friendship andsupport particularly in difficult clinical situations such asthe management of clinical errors and complaints. Aneffective arguing for resource management can duly beaddressed.It is high time for all the Pakistani speacialists involvedin the care and management of cancer patients to comeforward and establish these boards both in private andpublic sector hospitals. Hopefully, we would go through the same flux, and afterinitial teething problems, non-oncology colleagues canbe convinced to come forward and help in the formationof these team meetings, which can be conducted on aregular basis with a view of discussing all the newlydiagnosed cases of cancer.Keeping the above mentioned facts in view, someconsultant colleagues across the country are trying tospare their times from busy academic and clinicalcommitments for the Tumour Boards but more compre-hensive and generalized efforts are required in order toachieve a 100% coverage. All teaching hospitals inPakistan have the vision of establishing these tumourboards in their institutes. Some have already started andsome are in the process of establishing them. The AgaKhan University Hospital, Karachi, is a tertiary referralteaching hospital where a Friday morning weeklytumour board is taking place since last many years.Specialist colleagues from almost all major hospitals inKarachi attend this tumour board and present and givetheir independent expert opinions on complex cancercases . Site-specific tumour boards, e.g. Breast, Headand Neck, Orthopaedics, Gynaecology, Paediatrics,Thyroid, etc. are being established as well. The finaloutcome is documented in the patients’ case notes.During the Board meetings postgraduate traineespresent the cases and according to our experience, thatserves as the best form of their structured training asthey openly discuss cases and learn how to tackledifference of opinion. Multi-disciplinary presence gives asense of team ownership of the cancer patients. At thispoint it is important to clarify that cases of otherhospitals are also welcomed here and our colleaguesworking elsewhere are also given the opportunity topresent and discuss their cases. These mutual sessionshave lead to fruitful decisions, benefiting patients andsaving cost and time.Such tumour boards have also been started at someother public hospitals but the need is to spread thepractice to encompass the whole spectrum of newcancer cases as much as possible.REFERENCES1. Bhurgri Y, Bhurgri A, Nishter S, Ahmed A, Usman A, Pervez S,et al. Pakistan--country profile of cancer and cancer control1995-2004. J Pak Med Assoc 2006; 56:124-30.2. Fallah M, Kharazmi E. Global cancer incidences are260 Journal of the College of Physicians and Surgeons Pakistan  2011, Vol. 21 (5): 259-261Ahmed Nadeem Abbasisubstantially under-estimated due to under-ascertainment inelderly cancer cases. Asian Pac J Cancer Prev 2009; 10:223-6.3. WHO. International Agency for Research on Cancer. About cancermondial [Internet]. [updated 2004]. Available from: http://www.dep.iarc.fr/4. Quinn MBP, Kirby L, Brock A. Registrations of cancer diagnosedin 1994-1997, England: Office for National Statistics; 2000.5. Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancerincidence and mortality in Europe in 2008. Eur J Cancer 2010;46:765-81.6. Department of Health. The NHS cancer plan: a plan forinvestment a plan for reform. London: Crown Copyright;2000. 7. Nguyen NP, Vos P, Lee H, Borok TL, Karlsson U, Martinez T,et al. Impact of tumour board recommendations on treatmentJournal of the College of Physicians and Surgeons Pakistan  2011, Vol. 21 (5): 259-261  261Cancer management is a multidisciplinary team workl l l l lOl l l l l

Cancer management is a multidisciplinary team work

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Cancer management is a multidisciplinary team work

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