The MDT Flashcards
What is an MDT
‘A multidisciplinary approach involves drawing appropriately from multiple disciplines to explore problems outside of normal boundaries and reach solutions based on a new understanding of complex situations’
What does the cancer MDT make up
is made up of a variety of health professionals involved in treating and caring for patients, such as surgeons, clinicians, nurses and diagnosticians
What does the MDT do each week
Each week, the MDT meets to discuss individual patients’ cases and make treatment recommendations.
what is considered the gold standard for cancer patient management
the MDT
What does the MDT allow
All patients receive timely treatment and care from appropriately skilled professionals
Continuity of care
Ensure patients get adequate information and support
Facilitate communication between primary, secondary and tertiary care
Collection of reliable data – audit/research
Promote effective use of resources
Improve participants working lives
Give an example of how the MDT works
See new patient in clinic
Email MDT Coordinator to add patient to appropriate MDT
- What is the question for the MDT?
- What material needs to be reviewed?
Coordinator produces patient list for MDT each week
MDT runs Tuesday AM from 8-10
Attended by haem-onc consultants, pathologist, radiologists, clinical nurse specialists, radiation oncologist, junior staff
MDT proforma completed after the discussion and uploaded to patients notes
Aim to see the patient back in clinic following on from the MDT
What are the problems with the MDT
Increasing numbers of patients of increasing complexity requiring discussion
Increased workloads particularly for pathologists and radiologists to prepare for the meeting
Poor attendance
Having the right information available at the right time to make the correct decision
Inability to fulfil secondary roles
What are the specific dates of the two week waiting pathway
- 14 days from point of receipt of referral to the point where they are seen
- 62 day pathway – point of GP recipient to treatment
- 31 days pathway – point of decision to treatment
how many people are diagnosed in the two week waiting pathway with cancer
1 out of 10
- 9 out of 10 people are referred in this way are not diagnosed with cancer - have something else
Who is the specialist that the person will see after the two week waiting pathway
Often a surgery or a general physician depends what the symptom is
- Altered bowel habit
- Breast lump
- Haemoptysis/persistent cough
- Weight loss
when do you seen an oncologist
after you have been diagnosed with cancer
What happens in the consultation with the specialist
History
- Presenting complaint
- Past medical history (co-morbidity assessment)
Examination
Investigations
- Blood tests
- Biopsy
Scans
Follow-up appointment arranged to get results
Whose responsibility is it to give results
It is the responsibility of the investigating consultant to give the patient those results
How should you present results to the patient
Ensure results are reviewed prior to seeing patient in clinic
Contact relevant oncologist / haemato-oncologist and CNS in advance
- So you know what to tell the patient
- So you can tell them when they are going to be seen by the relevant specialist
What is important in communication with telling someone that they have cancer
Explore expectations
‘Warning shot’ – the scan had some bad news
Give information at the patient’s pace
Allow the patient time to react
Elicit concerns
What does CNS stand for
Clinical Nurse Specialist
What is the role of the CNS
- manage the patients journey
- explain and coordinate everything - booking the slots for chemotherapy, council the patients to the side effects of the chemotherapy
- support
shared care
treat
referral to benefits and social housing
What is the role of the CNS within the MDT
Ensure staging investigations done in a timely manner liaise with MDT co-ordinator
Present patients to the MDT
Inform the patient when they will get their results
Patient advocate
what are the standards for the Royal College of Radiologists
15 standards in total:
Radiologists must attend two-thirds of the MDTs
A minimum of 2 radiologist must be allocated per MDT.
There should be prior review of all imaging
All imaging discussed at MDT should have a supplementary report with TNM staging and ongoing management plan.
Discrepancies between the radiological report and surgery/pathology findings should be documented.
What is the benefit and disadvantage of x ray as an use of imaging
Very cheap , low sensitivity
What is the role of imaging in cancer
Symptoms:
- Relevant modality used in view of symptoms and degree of clinical concern.
Screening:
- Breast Cancer Screening – 4yearly mammography - Lung Cancer Screening – Lung CT - Bowel Cancer Screening – CT Colonography
Incidental Pickup:
- Lung nodule at the top of a CT Abdomen - Renal mass on routine abdominal ultrasound
What are the advantages and disadvantages of ultrasound
- No radiation ,
- cheap,
- variable
- useful in basic interventional procedures..
- operator dependant
what is the standard and most common modality of choice now used for imaging
CT
what is the risk of CT dose
involves radiation
What is the advantages and disadvantages of MRI
Advantages
- No radiation
Disadvantages
- expensive
- claustrophobic
- time consuming.
What is MRI good for
it is good for local T and N staging of a tumour
What does FDG-PET identify areas of
FDG-PET identifies areas of increased metabolic activity.
what does bone scintigraphy do
Bone scintigraphy identifies areas of increased osteoblastic activity.
name some other imaging uses
Biopsies
- CT and US guided
Venous and enteral access
- Hickman/Port-A-Cath , PEG/PEJ tubes
Palliative stenting
- Biliary and ureteric stents
What does a pathologist do
Defines classification – current classification centered on histopathological findings
Definitive diagnosis – determines treatment
Biomarkers – CD20 (Rituximab), CD30 (Brentuximab), CD52 (Campath)
Molecular testing: FISH, PCR, Cytogenetics
Feeds into database for clinical research
Supports research – tissue based research and trials
Audits – radiological and clinical diagnosis
Informs the Cancer Registry and Epidemiological studies
Audits work of colleagues in pathology
Helps inform future classification – currently pathology based.
What are the different types of pathology
- Haematology Lab – uses analysers, flow cytometer
- Histopathology lab – tissue analysis and biomarkers, CD20
- Molecular pathology
What does a pathology report include
- Blood counts
- Flow results- B cell population, phenotype, CD20, CD10
- Aspirate report
- BMT report – 70% infiltration by FL CD20+
- Biomarkers
- Molecular (FSH, cytogenetics)
- BMA – lymphoid infiltrate
- immunohistochemistry
