Team Oncology vs. Cancer: The World Series

Cancer.  Nobody wants to hear that they have it.  A  cancer diagnosis is an emotional moment.  It often  carries connotations of fear, anxiety and thoughts of the worst possible scenarios.    Cancer is not a single disease.  It’s different for every patient, and thankfully, we’re learning more about it everyday.  Cancer patients have an entire team, “Team Oncology,” behind them throughout the diagnosis and treatment of their disease. Thankfully, I have never been in that chair to receive said diagnosis, but my work in oncology patient care has shown me the amazing accomplishments that teamwork can achieve in improving patient outcomes.

Oncology care  is a different ball game.  Oncology providers work in one of the most exciting and challenging areas of medicine. With this comes additional psychosocial challenges , high levels of patient related emotional demands, and a need to find balance in combination with the normal day to day provider stressors, such as paperwork and managed care coverage.   Being an expert in all facets of oncology would be impossible.    This is why teamwork is so important in oncology care.  A multidisciplinary (multi-d) team approach to cancer care brings together experts from many oncology specialties: medical oncology, pathology, radiation oncology, care navigation, and surgery, to name a few.  These teams work together to create a personalized, effective treatment plan for each patient.  A 2010 UNC study found that using a multi-d approach

 changed the initial diagnosis or treatment recommendations for patients in almost 65 percent of cases.

Remember when I said there’d be more to come on virtuoso teams?  Well here it is.   This is not your ordinary team.   This is a team of experts from their respective realms of oncology, coming to the table to design a plan of attack against cancer.   Think Boston Red Sox vs the Yankees.  Winning one time will never be enough for either team. Status quo and complacency will never be enough for any cancer care team.

cancer careHere’s the sweet: these teams are working together in the best interest of the patient. The overarching goal is to design plans that result in excellent clinical outcomes for patients and the best quality of life possible.

Here’s the tart: even the best teams can fail and the plan might not work as intended. Cancer doesn’t always play by the rules and there is no umpire to call it safe. Studies can show us how it might act, what we can expect it to do, and each treatment plan these virtuoso teams create is designed to put the odds in the patient’s favor.

Studies have shown that multi-d approaches to cancer care leads to improved decision making, better patient outcomes and increased patient and caregiver confidence.  A March 2007  publication in the Journal of Oncology Practice suggested that collective decision making may falsely reduce an individual provider’s sense of responsibility in the decision making process and that inherent bias for referral patterns to participants of multi-d teams will occur.  Other pitfalls might be a consistent deferral to a strong opinion carrier, or most senior member of the team, groupthink and fear of idea rejection.  It does not argue the benefits of a multi-d approach, however it suggests that being aware of possible pitfalls is crucial to success of these teams. Being self aware and team aware is important for any team, regardless of its area of expertise.

A 2012 publication by Nabila Chowdhury and Sandra M. Swain (the current president of ASCO), highlights the true benefits of collaborative patient care in the management of patients diagnosed with inflammatory breast cancer:

“A multidisciplinary approach provides a rational and coordinated mechanism for evaluation and treatment of patients with IBC by bringing providers in the surgical, medical, radiation oncology, pathology, and radiology disciplines together. The approach is enhanced with the involvement of a dedicated care coordinator who manages the care process. This figure plays an important role in communication of the care plan to the patient as well as seeing that the care needed is arranged and delivered. The psychosocial and palliative care services are also closely involved in the care of the patient. This care process enables the patient to make informed treatment decisions and be reassured that all her physicians are working in close conjunction for better management of her case. This in turn leads to more patient satisfaction and ultimately to more favorable outcomes for the patient.”

That’s the kind of team I want on my side.  A virtuoso team that might not always agree on every point initially, and that is willing to challenge its members to design creative treatment solutions that lead to excellent clinical outcomes for their patients.

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