Lung cancer is the most dangerous malignancy to human health and life in the world today. In the United States, lung cancer is the leading cause of death among malignancies in both men and women, with approximately 219,440 new lung cancer cases and 159,390 lung cancer deaths in 2009 [1]. A 2008 study published in the Lancet reported that the smoking rate in China in 2003 was 49.6% for men and 3.0% for women, and if this situation is not improved, 18 million people will die of lung cancer in China by 2033. China will also become the world’s largest lung cancer country. Thus, we can see that lung cancer has become one of the most difficult problems among malignant tumors at home and abroad. Most of the major advances in clinical oncology are related to comprehensive treatment, and it is this interdisciplinary collaboration that has improved the cure rate of lung cancer.
1. Background of the virtual model of multidisciplinary comprehensive lung cancer diagnosis and treatment and the current situation of multidisciplinary comprehensive lung cancer diagnosis and treatment in China
Multidisciplinary comprehensive diagnosis and treatment of lung cancer refers to the planned and rational application of various existing multidisciplinary effective treatments according to the physical and mental conditions of lung cancer patients, the specific location, pathological type, invasion scope and development trend of tumors, combined with the changes in cellular molecular biology, to achieve the best treatment effect with the most appropriate economic cost, while maximizing the quality of life of patients [3]. Undoubtedly, the concept of integrated multidisciplinary treatment of lung cancer has been recognized by the majority of clinical oncologists in China, but most of the integrated treatment of lung cancer still remains at the stage of paperwork, and no substantial progress has been made. Why is the current status quo? It is very meaningful to analyze the causes of the current situation in order to get out of the current dilemma.
1.1 The system of subspecialization restricts the development of multidisciplinary comprehensive lung cancer diagnosis and treatment
Medicine in the 20th century is specialized medicine, and medical subspecialties are becoming more and more detailed. Patients often have to go to different departments for a single disease. Obviously, analyzing the complex condition of the whole human body with limited professional knowledge will inevitably lead to limitations in analysis or errors in judgment, often resulting in unnecessary losses to the patient. In addition, in China, due to the economic interests of various specialties, it will often result in whoever sees the patient first will first deal with the patient according to their specialty, and there is no long-term comprehensive treatment plan. M. Planck, a physicist and founder of quantum theory, once said, “Science is intrinsically whole and is broken down into separate divisions depending not on the nature of things but on the limitations of human cognitive ability.” The history of science shows that science has undergone the process of synthesis, differentiation and re-synthesis, and medical science also follows such a rule. Therefore, multidisciplinary comprehensive diagnosis and treatment of lung cancer is inevitable.
1.2 Lack of leading talents
The current training system of physicians in China is not yet able to train a group of leading talents who have deep knowledge of various disciplines. This is the basic quality that the leading talents should have. They should be able to apply the knowledge of multiple disciplines, conduct interdisciplinary analysis and think about the current difficulties of lung cancer, and carry out In this way, we can improve the quality of diagnosis and treatment, reflect the patient-oriented purpose, and create a new way for the development of the discipline.
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At present, there are still doctors in China who treat patients based on their personal experiences, some of which are far from the guidelines and norms, and they are not able to summarize the treatment data from previous clinical practice in a timely manner, take the essence and remove the meal, and do not think forward, so they are unable to carry out some innovative work, and China’s international voice in the field of lung cancer is relatively weak. Although some impressive achievements have been made in some local regions in recent years, there is still much room for improvement nationwide.
2.The emergence and development of the virtual model of multidisciplinary comprehensive lung cancer diagnosis and treatment
At present, some insightful people in China have fully recognized these problems and started some very meaningful exploratory work with very good results, such as Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute, Shanghai Chest Hospital Lung Cancer Clinical Medical Center, etc. Their multidisciplinary integrated diagnosis and treatment model is a physical integration model, which is an effective physical integration of internal medicine, surgery, radiotherapy, psychological medicine, etc. Their multidisciplinary integrated diagnosis and treatment model is a physical integration model, which is an effective physical integration model of medical, surgical, radiotherapy, psychological medicine and other disciplines into one medical unit for treatment. This is a very idealized model, but it is difficult to promote this model effectively due to the existing medical system in China. How to better solve the current dilemma of multidisciplinary integrated diagnosis and treatment of lung cancer in China, and how to promote it effectively? The purpose of the virtual integration model is patient-centered, academically linked, and multidisciplinary collaboration for joint development. In the absence of physical integration of specialty entities, each specialty is integrated virtually through a virtual model. We have been running this model since 2004, and with the passage of time and accumulation of practice, we have been improving it to make it more suitable for this special soil in China and form a win-win situation for doctors and patients. From 2007 to 2008, we carried out small-scale promotion in local areas, and this model will soon take root and bear fruit in new areas.
3. Specific implementation plan of the virtual model of multidisciplinary comprehensive diagnosis and treatment of lung cancer
3.1 Formation of lung cancer multidisciplinary comprehensive diagnosis and treatment expert group
The lung cancer multidisciplinary comprehensive diagnosis and treatment expert group is composed of multidisciplinary experts from respiratory medicine, medical oncology, radiotherapy, traditional Chinese and Western medicine, thoracic surgery, interventional medicine, medical imaging, pathology, pain, etc. A chief expert is elected through competitive recruitment, and each specialty is composed of one expert and one young physician, which is beneficial to the development of the organization. In addition, each specialist is equipped to master and manage a medical team in his or her specialty, which is conducive to the transition of patients between different departments.
3.2 Establishment of a joint outpatient center for multidisciplinary comprehensive lung cancer diagnosis and treatment
The joint outpatient center performs two functions: joint outpatient clinic and joint consultation. The joint outpatient clinic is jointly attended by experts of the group and provides one-stop service, so that patients can enjoy multidisciplinary expert consultation service with only one registration number! On the one hand, it formulates scientific and standardized diagnosis and treatment and follow-up plan for each lung cancer patient, and admits patients from which department they belong to; on the other hand, it conducts standardized and scientific analysis of existing patients from various specialties, and transfers them to which department for treatment. In this way, patients can receive the most optimal treatment plan, save medical costs and optimize medical resources, while specialists from different specialties can learn from each other, improve together, eliminate academic bias and create a good academic team to better serve patients. 3.3 Establishment of a secretary system for multidisciplinary comprehensive lung cancer diagnosis and treatment
A secretary is set up in the center, who is subordinate to the department of the chief specialist, mainly engaged in the appointment of patients, the writing of medical documents of the joint clinic, the coordination among departments, the management of patient history database, the follow-up of patients, the management of specimen library, and the maintenance of the website of the multidisciplinary comprehensive lung cancer diagnosis and treatment center.
3.4 Establishment of a sound patient history database
The clinical database and the local network system of the multidisciplinary lung cancer treatment center will be established, and the trainer of each specialty will be responsible for the entry of the main clinical data of the medical history of lung cancer patients in each specialty, and the secretary will be responsible for the entry of the medical history of the outpatient clinic.
3.5 Establishment of lung cancer specimen bank
The SOP of the specimen bank is formulated by the chief expert, and the hardware facilities required for the specimen bank are provided by the department where the chief expert is located. The specimen collection work of each specialty is carried out and stored by the cultivator of each specialty according to the SOP specifications formulated, so as to lay a solid foundation for clinical research.
3.6 Establishment of the website of the Multidisciplinary Comprehensive Lung Cancer Diagnostic and Treatment Center
The center will release more academic frontier information and popular lung cancer knowledge through the website from time to time for doctors and patients to learn and exchange; open the online outpatient appointment function to facilitate patients, especially foreign patients, to make appointments for consultation; the secretary will make final confirmation of patients who have made appointments for consultation on the same day, reasonably arrange patients’ consultation time, and open online expert consultation activities to realize seamless link between patients and doctors.
3.7 Establishment of multidisciplinary comprehensive diagnosis and treatment salon for lung cancer
Regular academic activities are held, and the activities are divided into three aspects: first, study of lung cancer norms and their progress to update knowledge in a timely manner; second, case discussion, establishing a topic each time, providing relevant cases on this topic, leading from the cases to the corresponding topic, and enhancing the consolidation and expansion of knowledge on the topic through discussion, such as the discussion of treatment strategies for refractory malignant pleural effusion. Third, regular literature reading is conducted to look for some prospective research directions, which can be made to move from clinical to experimental and then from experimental to influence clinical practice through the platform of the specimen database. Fourth, timely analyze, summarize and organize the information in the database, and establish our own theoretical system and fat ひ窖еぞ荨
4.Effectiveness of the virtual model of multidisciplinary integrated diagnosis and treatment of lung cancer
After 5 years of implementation and operation, the virtual integrated multidisciplinary diagnosis and treatment model of lung cancer has achieved good results, mainly in the following aspects: (1) more than 1,000 new patients have been admitted and treated through this model, and all hospitalized patients have been treated through this pathway; (2) the joint development of individual treatment plans by various disciplines, scientific application of surgery, radiotherapy, interventional therapy, chemotherapy, biological therapy, traditional Chinese medicine and other treatment methods, and the combination of cellular molecular biology changes. The survival rate of patients is obviously improved by the individualized treatment combined with the change of cellular molecular biology, and each person is given the best treatment plan according to their respective conditions; (3) the one-stop service and network telephone reservation service facilitate patients’ access to medical treatment, and patients can be effectively transferred from one treatment method to another due to the collaboration between specialists of each specialty. (iv) The medical technology level of the team and the medical technology of the team ④The medical technology level and clinical research level of the team are obviously improved, and in the process of multidisciplinary collaboration, we can continuously enrich our own medical knowledge, and effectively improve the clinical research level on the basis of the database and specimen bank. With the joint efforts of the team, more and more patients have come to our clinic, and the number of outpatients and inpatients has increased significantly, which can significantly improve the economic benefits of each department through the advantages in quantity while saving patients’ medical costs.
5. Application prospects of the virtual model of multidisciplinary integrated diagnosis and treatment of lung cancer
We believe that the widespread promotion of this model can rapidly improve the overall multidisciplinary comprehensive lung cancer diagnosis and treatment in our country, and the majority of lung cancer patients will become the largest audience, improve the survival rate of lung cancer patients, save the overall medical cost, and adapt to the national medical reform. In addition, if each center operates according to standardization and shares information from each center, we believe that in the near future, we will participate in more international multicenter clinical trials and our country will have more and more international voice in the field of lung cancer!