People who receive a diagnosis of cancer are highly stressed, and so too are their families. The pathway to the diagnosis of cancer is characterised by a particular form of psychological stress: the stress of waiting. Much of this is simply unavoidable, involving referral, appointment, investigation, biopsy, and planning treatment.
It is in the planning of treatment that the agony of waiting can be reduced. This could be accomplished by a simple stroke of the pen – get rid of the routine insistence for tumour boards or MDT (a Multi-Disciplinary Team of health professionals who work together to plan treatment best suited for the patient).
The genesis of the MDT seems to lie in the idea that a single clinician cannot be trusted to set the patient off on the appropriate pathway. When I have asked specialists about this, they have sometimes replied that it will prevent rogue surgeons doing unnecessary operations, citing the notorious case of Ian Paterson.
These are very weak arguments for routine referral to the MDT. First, the treatment for most patients is based on a standard protocol. Experienced physicians and surgeons are quite capable of following these guidelines; it is part of their job description. Second, the argument regarding rogue surgeons is simply not tenable; why should tens of thousands of patients wait an extra couple of weeks, because of one notorious case?
A recent article in JAMA underscores the need to shorten the cancer pathway as much as can be safely achieved.[1] Moreover, there are good clinical grounds to shave time off the pathway. Much effort and work has gone into reducing the time between symptom and referral. This is because the evidence that delay reduces the chance of the cure, is extremely strong. Every month of waiting between diagnosis and surgery has been estimated to increase all-cause mortality by around 6-8%.[2]
I am not arguing that there should be no MDT Referrals, however. Of course, there are instances of complex cases that cannot be solved by guidelines alone. MDT referrals should be reserved for such cases.
— Richard Lilford, NIHR ARC West Midlands Director
References:
- Gupta A, Johnson WV, Henderson NL, et al. Patient, Caregiver, and Clinician Perspectives on the Time Burdens of Cancer Care. JAMA Netw Open. 2024; 7(11): e2447649.
- Hanna T P, King WD, Thibodeau S, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020; 371: m4087.