Interdisciplinary management of cancer: the surgical perspective

Abstract

Inter-disciplinary care for the cancer patient has become standard of care in many countries. The perceived advantage is that the most optimal patient care can be delivered, which ultimately results in lower morbidity and mortality rates, and better survival for patients. With advances in disease diagnosis and management, more options are available and multidisciplinary care is inevitable. For gastrointestinal cancers, many specialists can be involved, including epidemiologists, gastroenterologist, hepatologists, radiologists, nuclear medicine physicians, and surgeons. All phases of patient care are affected, from disease prevention to diagnosis, staging and management. From an organization point of view, tumor boards, which have become popular and even mandatory in some countries, may be an efficient way of co-coordinating cancer services, enhancing communications among different specialists, facilitating knowledge transfer and training. Research is enhanced by interdisciplinary care. Patient and data ownership may vary among institutions, and this may affect personal financial remunerations, professional development, and resources allocation.

The proliferation of multidisciplinary therapies has led many to believe that such treatments should be the standard practice. This must be viewed with caution since, despite widespread use, often their efficacies have not been proven by randomized controlled trials. Even the results of randomized trials can be contradictory to each other. There are in addition difficulties in transferring the results from such studies to daily community practices.

For diseases which are primarily managed by surgical resection, the surgical oncologist should play a pivotal role in patient care, as the gatekeeper and overall director of therapy. Multidisciplinary management may be the counsel of perfection for some conditions, but these must be evidence-based and cost-effective.