Central to cancer management in the modern era is the role of a multi-disciplinary team (MDT) meeting, which optimizes coordination between healthcare professionals in their management decisions of patients. Enabling better coordination and communication, MDTs have facilitated improved decision-making amongst specialists benefitting patient care immensely1-3. As the standard of care in most countries, MDTs have positively influenced patient assessment and management practices in cancer care especially with modification of diagnosis, thereby ensuring the appropriate treatment plan is undertaken4-6.
Following the implementation of the National Cancer Act in 1971 in US by President Richard Nixon, there was increased emphasis on collaboration among different specialities to deliver coordinated care, which initiated MDT-based care in cancer patients7-9. By 1989 in the US, over 90% of hospitals with greater than 100 beds and 85% of the hospitals with fewer than 100 beds had a tumour board to deal with cancer care8. In the UK, following the recommendations of the Calman-Hine report in 1995, MDTs have become the norm with almost all cancer cases in the UK having their management discussed in an MDT setting9. Nowadays, MDTs meetings have been widely implemented in many countries including UK, Australia, and Europe and also in developing ones1, 9. Although they were initially employed in the management of common cancers (breast, gastrointestinal, lung and colorectal)10 they are now being commonly used in rare tumours too such as pancreas, lymphoma and sarcoma11.
Unlike other cancers, bone and soft tissue tumours (BST) and their MDTs are unique in many ways. Primary bone and soft tissue tumours are a rare form of cancer accounting for less than 1% of all diagnosed malignancies11. In 2010, there were 531 new cases of bone sarcoma and 3298 new cases of soft tissue sarcoma in the UK, in stark contrast to nearly 55,200 new cases of breast cancer reported every year. In addition to their low incidence compared to other tumours, they have a broad presentation12. They may involve any region of the body and any part of the skeleton, thereby bringing in the role of site-specific surgeons. These tumours also have a bimodal age specific incidence rate with peaks in incidence seen in teenagers and young adults (TYA) and elderly patients. The rarity of these cases, coupled with the complexity in management and presentation, warrants treatment by specialists with training and expertise in musculoskeletal oncology.
There are five reference centres in the UK approved for the management of BST, each with a fully accredited MDT12. In a routine BST MDT in the UK, apart from discussing bone and soft tissue malignancies, the meetings are also a platform to triage complex musculoskeletal diseases including infections and ‘tumour mimicking conditions’. Hence, the diagnosis and treatment planning of these conditions in an MDT meeting involves a diverse range of specialists. In our sarcoma service, more than 35 members attend the weekly MDT, chaired by an orthopaedic oncology surgeon and a musculoskeletal radiologist, in order to formulate an appropriate management pathway for all referred patients. The number of active participants in these meetings is an essential element in the decision-making process and, therefore, in the delivery of effective treatment to cancer patients.
One of the key limiting factors to optimal functioning of an MDT is the inconsistent attendance of essential specialists at meetings13, 14. Bringing together all clinicians under one roof is a practical problem and non-attendance of key personnel hampers and delays decision making in an MDT. This is a greater problem in BST MDTs where multiple specialists are involved. To overcome this problem, teleconferencing and the use of virtual platforms have been proposed but rarely used to date1, 15, 16. Conventional face-to-face MDTs are still practised across cancer networks worldwide and remain the standard of care.
The COVID-19 pandemic has placed an unprecedented strain on healthcare systems globally, including the more time critical services, such as cancer and trauma17, 18, 19. Essential services must continue unhindered, as any delay in treatment would result in adverse patient outcomes and also increase mortality. Maintaining a routine MDT to triage cases is absolutely imperative. Due to the enforced social distancing measures and the risk of healthcare professionals contracting the disease, the pandemic necessitated MDTs being switched to virtual platforms20.
We wanted to not only evaluate the efficacy of this exercise among participants, but we also aimed to assess whether this could represent the future of cancer care. We collected the opinions of all participants (core and extended members) of our Sarcoma MDT and surveyed their opinions on MDTs over virtual platforms compared to conventional face-to-face MDTs (Table 1).
List of healthcare professionals routinely attending the MDT at our Sarcoma Service
Paediatric Orthopaedic Surgeon
Sarcoma Specialist Nurses