The RCP and other expert bodies are calling for an overhaul of how cancer treatment decisions are made in order to improve patient outcomes amid rising demand and increasingly complex treatment options.
In a briefing published today by the Royal College of Radiologists (RCR), the Royal College of Physicians has joined the Royal College of Nursing (RCN), Royal College of Pathologists (RCPath), and the Association of Cancer Physicians (ACP) in urging the Government to use the upcoming National Cancer Plan for England to kick-start reform of how cancer multidisciplinary teams (MDTs) work.
They say this is a critical opportunity to reform cancer decision-making, after past NHS England efforts to trial streamlining MDT meetings (MDTMs) suggested this would create fairer access to the NHS’s world-class cancer treatment options, give clinicians more time with patients, and save costs.
Multidisciplinary team working is a cornerstone of cancer care, with the weekly MDT meeting its main vehicle. This way of working should enable collaborative, patient centred decision-making as well as a focus on quality improvement, audit and research. But current practice isn’t living up to that promise.
Increasingly overloaded meetings are resulting in rushed discussions of variable quality, a heavy time burden for clinicians and even delays to patient care.
Evidence suggests the current way of working is not facilitating equitable access to specialised treatments, despite this being the rationale for introducing MDT working. The National Cancer Audit Collaborating Centre (NatCan), for example, warns that 30% of patients with high-risk prostate cancer do not get access to curative radiotherapy or surgical treatment, with performance varying between 20% and 43% across different services.
It has become established practice for every single patient to be discussed at cancer MDTMs, often more than once. While NHS England has issued guidance to focus discussions only on the more complex patients, this has largely not been adopted.
As demand for cancer care rises, MDTMs need a major redesign to focus on service improvement and reducing the unacceptable variation in access to treatment. MDT working will remain essential to cancer care, but the approach must change to meet the evolving needs of patients. In England, halving the number of patient discussions could save the NHS an estimated £300 million per year.
The RCR, RCP, RCN, RCPath and ACP agree that MDTMs should be:
- Only used to discuss the most complex cases that will genuinely benefit from an in-depth review
- Repurposed for activities like quality improvement and training, using relevant data to review and improve processes
- Attended only by those who are required and who can actively contribute
- Not used as the sole decision-making forum for cancer treatment. Instead, teams should be equipped with pathways and protocols to make faster, more consistent and more equitable treatment decisions
- Truly focused on patient-centred care – for instance, reducing inappropriate tests for patients with multiple comorbidities
- Used to collect and analyse high quality, consistent data in order to inform service development.
For these reforms to be safe and effective, it is critical that clinicians are supported with nationally agreed guidance, pathways and protocols, and that the patient voice is involved in the reform process. The RCR has offered to lead this work, which could include agreeing optimal treatment pathways and protocols for radiotherapy and chemotherapy, to avoid duplication of effort.
Dr Hilary Williams, Clinical Vice President at the Royal College of Physicians and consultant in medical oncology, said:
“Cancer care in England is under significant pressure, with delays in diagnosis and treatment affecting far too many patients. This is unacceptable and should not become the norm.
It is crucial that senior decision makers, supported by multidisciplinary teams, have the time needed with patients to help them understand the options they have available, and ensure care is delivered effectively and in a patient-focussed way. What is needed is a sea change in how clinical decisions are made. Part of the answer lies in working smarter, not just harder. Looking at how we can reform multidisciplinary team meetings in cancer care could be a gamechanger – for example streamlining unnecessary process and enabling teams to focus their expertise where it makes the biggest difference.
We need to ensure patients receive the right treatment faster, reduce delays and reassure families that time is being spent on what matters most – improving outcomes for patients. We hope government will consider this proposal as it develops the National Cancer Plan for England.”
Dr Tom Roques, vice-president for clinical oncology at the Royal College of Radiologists, said:
“While collaborative working is essential to cancer care, inefficient MDT meetings are too often delaying patient pathways. We need to face facts – how we do things now is outdated, and as a result we’re missing opportunities to reduce inequalities in access to the best treatments.
The National Cancer Plan is a critical opportunity to get cancer decision-making right for the long term. We must reform how cancer teams work, focusing our limited resource where it will make the most difference – discussing only the most complex cases in the MDTM, and concentrating more on service improvement. We urge the Government to take forward our recommendations and we stand ready to lead this change.”
Professor Andrew Wardley, chair of the Association of Cancer Physicians, said:
"Cancer medicine has seen enormous advances over the last 30 years. Time to treatment remains hugely important to achieving the best outcome.
There are protocols and pathways, which are published. Delaying treatment for a week, or less frequent management of treatment is inappropriate. At present, overloaded MDT meetings too often delay care and dilute the quality of clinical discussions.
ACP strongly supports reform so that cancer clinicians spend more time with patients, ensure timely access to the best treatments, and reduce unacceptable variations in care.
MDT working will always be central to cancer services, but it must evolve to meet today’s challenges and deliver the consistent, patient-focused care our patients deserve.”
Dr Bernie Croal, president of the Royal College of Pathologists, said:
“Multidisciplinary team meetings are crucial but need a radical overhaul. Given the workforce shortages the profession is facing, with 80% of cellular pathologists believing current staffing levels are inadequate to meet growing clinical demand and ensure long-term sustainability of their services, reform is essential to make services more efficient and ensure their focus optimises patient care.”