The multidisciplinary management of patients with cancer.

We read with interest the recent article by Blazeby et al. [1], which described the implementation of decisions made by a multidisciplinary team (MDT). The study evaluated 273 decisions about patient management made at a central MDT meeting in Bristol, which assessed cases of patients with upper gastrointestinal cancer, including cases from several surrounding satellite hospitals. They found that 41 of 273 (15%) decisions about treatment made at the MDT meeting were not implemented. In the majority of cases this resulted in patients receiving a more conservative treatment than suggested by the MDT. The main reasons why decisions were not implemented were co-morbid health issues (44%), patient choice (34%) and decisions being changed when more clinical information was available (20%). In this study it was not possible to evaluate the quality of the decisions made at the MDT. These findings highlight some important issues regarding the multidisciplinary management of cancer patients. First, in order for MDT meetings to function effectively they require adequate information about the patient’s disease as well as any physical or psychological co-morbid health issues. It is also recommended that information about the patient’s concerns, preferences and social circumstances is presented at the meeting by someone who has met with the patient, such as a specialist oncology nurse or the treating physician [2]. Ideally, this would be done by teleconference for patients from satellite centres. At our centre, a nurse coordinator Annals of Oncology letters to the editor