Ask The Doc - Multidisciplinary Cancer Care

Monday, October 12, 2015

Question: What is a multi-disciplinary clinic and how does it affect cancer care?

By Dr. Alysandra Lal, MD, Surgery and Medical Director, Columbia St. Mary’s Breast Cancer Program

Like most things in life, when it comes to breast cancer care, communication is vital. Poor communication among specialists, departments and the patient can cause confusion about the diagnosis and treatment plan, leading to delay of care.

That’s why at Columbia St. Mary’s, we decided to treat breast cancer differently.

A multidisciplinary clinic is a care model based on a disease process rather than a specialty clinic. Columbia St. Mary’s breast cancer multidisciplinary clinic offers a patient who is newly diagnosed with breast cancer a single opportunity to meet with all the providers who will participate in her care – one day, one time, one appointment. For the patient, that means that after one day of consultations, she has a good sense of her treatment plan and the providers who will be caring for her.

The strength of the clinic actually occurs hours before the patient arrives, though. Twice a week at Columbia St. Mary’s, the entire cancer care team holds a multidisciplinary conference in which we discuss all the patients who are newly diagnosed with breast cancer. Before the conference takes place, one of our nurse navigators – the heart of the program – will have already reached out to the patient, learning about them personally and inquiring about their health history.

The conference begins with an introduction by the nurse navigators. Then, a breast radiologist reviews the mammograms, ultrasounds and other pertinent imaging, and a pathologist shows the patient’s biopsy slides and any other relevant pathology. The surgeon, medical oncologist and radiation oncologist who will be caring for the patient will then present their treatment plan recommendations, which are examined and tempered by the rest of the team. We have a genetic counselor, a psychologist, research study coordinators, occupational therapists, a plastic surgeon, GYN and/or internal medicine physicians, and often members of women’s imaging and radiation therapy departments also in attendance.

This conference ensures that when the clinical team meets the patient, we all have the same information, have vetted our opinions and are offering the highest standard of care.

After the conference, each provider who will be involved in an individual patient’s care meets with the patient and her family one after another in our multidisciplinary clinic. This allows the patient to understand each element of her complex treatment plan from the expert in that field. The important themes of her diagnosis are repeated by each provider, which helps increase understanding.

Furthermore, by meeting with each provider, the anxiety of the unknown can be put aside and the treatment plan is quickly put into action. Patients express highest satisfaction with this clinic style that respects their time and the complexity of their care.

Our multidisciplinary conferences and clinics have helped Columbia St. Mary’s become innovators in our field. We received a grant from the Columbia St. Mary’s Foundation for occupational therapists to meet with patients for whom lymph node sampling is recommended prior to surgery to obtain baseline arm measurements that we hope will lead to earlier diagnosis and treatment of lymphedema, or arm swelling. We have a project in conjunction with our cardiac rehabilitation program that offers exercise programs to patients during chemotherapy, and we have developed more support groups for patients at all stages of breast cancer treatment as a result of patient needs identified in our multidisciplinary clinic.

There is also a large body of literature that shows the effectiveness of this team approach to cancer care. It helps guide accurate diagnoses, increases adherence to treatment guidelines and improves the overall quality of treatment. Multidisciplinary conferences have also been shown to reduce treatment variation and waiting prior to implementation of care, which increases patient satisfaction.

Such conferences have now become a standard for recognition in many national cancer care organizations. In fact, our conferences and clinics have recently led Columbia St. Mary’s Cancer Centers to receive the Outstanding Achievement Award from the American College of Surgeons Commission on Cancer and our inclusion in the Becker’s Hospital Review list of “100 Hospitals and Health Systems with Great Oncology Programs 2015.”

At Columbia St. Mary’s, we are very proud of our multidisciplinary breast cancer conferences and clinics and we believe that it is this type of integrated care that make us the regional leader in breast cancer care.

Dr. Alysandra Lal is a surgeon and medical director of the Columbia St. Mary’s Breast Cancer Program. For more information, contact 877-259-9358.

This article appeared in the Thursday, October 8, issue of The Ozaukee News Graphic.



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