When you have lung cancer, which department should you see? This seemingly simple question has caused many patients and family members to scratch their heads. The most important thing is that the patient has to go through a lot of different treatment options, including thoracic surgery, medical oncology, radiotherapy, interventional oncology, and pathology ……. The “full picture” and “roadmap” of treatment.
In fact, because of the complexity of the tumor and the limitations of current treatments, a single treatment is often not optimal; at the same time, each patient’s situation is different, and the treatment plan needs to be “tailored. Very often, the treatment of lung cancer is not a “one-size-fits-all” approach, but requires the joint participation of multiple disciplines to develop the best comprehensive plan, which is the basic concept of multidisciplinary collaboration. This is the basic concept of multidisciplinary collaboration, which has become an accepted model in the professional community for more scientific and effective management of the disease.
Let’s take a closer look at the specifics below.
What is multidisciplinary treatment of lung cancer?
Multidisciplinary treatment of lung cancer may involve physicians from multiple specialties, including surgical oncology, internal medicine, radiotherapy, interventional medicine, imaging, pathology, etc., who form a multidisciplinary team (MDT) to discuss and evaluate different treatments based on the patient’s specific situation (type of lung cancer, stage, site, gene expression, patient’s physical condition). The MDT will evaluate the suitability, efficacy, and adverse effects of different treatment techniques based on the patient’s specific situation (pathological type, stage, site, gene expression, and physical condition) and develop the best individualized plan, which will then be implemented by physicians from the relevant disciplines to bring maximum benefit to the patient.
This is like a battle before which generals of multiple services sit together to discuss the battle plan: who will spearhead, who will flank and surround, and who will break off the rear. Then each does his own job and works closely together.
What are the benefits of multidisciplinary treatment?
First, it facilitates finding the individualized plan that is best for a particular patient.
Lung cancer is a complex disease, a dynamic process that is multi-gene driven and progresses in multiple stages. The NCCN guidelines in the United States subdivide the stage IIIA (locally advanced) non-small cell lung cancer (NSCLC) and recommend different treatments based on whether the tumor invades a large blood vessel, whether the mediastinal lymph nodes metastasize, and so on. For patients with stage N2 NSCLC with single-site lymph node metastases, the guidelines recommend surgery combined with radiotherapy, but the decision to receive surgery or radiotherapy first still requires an MDT discussion.
For new molecular targeted therapies, immunotherapies, etc., the MDT also has to decide if, when, and how they should be used in combination with traditional radiotherapy.
In addition, MDTs help ensure that treatment is well regulated and rational.
The increasing sophistication of medical subspecialties is certainly beneficial, but it can also lead to a lack of knowledge of other specialties. For example, a medical oncologist may know a lot about the latest targeted drugs, but not necessarily about a new radiotherapy technique. If a physician “calls the shots,” he or she may not be thinking holistically and may not be developing the best plan.
Stage IIIA (N2) NSCLC is an example where surgery and concurrent radiotherapy are the standard treatment options. In the absence of MDT, the surgeon may operate directly and do remedial postoperative radiotherapy if complete resection is not possible; the radiation therapist may choose concurrent radiotherapy, and if he or she talks to the internist, he or she may find that sequential radiotherapy is a better option.
One study comparing treatment options before and after the MDT discussion showed that the MDT changed the course of treatment for about half of the patients. MDTs may also change the overall treatment strategy, allowing for more diverse treatment, which may improve quality of life and prolong survival.
This shows that MDTs deserve a lot of credit for overcoming biased decision-making by single-disciplinary physicians and developing the best treatment strategy.
Lung cancer multidisciplinary treatment is so good, but unfortunately, this advanced treatment model is not yet accessible to everyone because of the lack of medical resources in China. So, can the common interdisciplinary consultation replace MDT? The answer is: no. Common consultations are usually a point-to-point exchange between single disciplines, not a multidisciplinary decision.
In summary, if your primary care physician brings together multiple departments to discuss your condition and develop a treatment plan, you are enjoying an advanced model of lung cancer management – multidisciplinary collaborative care – that helps you get more individualized, standardized care.
Author: Dr. Peixin Tan, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute