LETTER TO THE EDITOR

What constitutes a multidisciplinary team meeting?ajco_1429 317

Dear Editor,Wilcoxon et al. recently report potential gaps in mul-

tidisciplinary cancer care in Australia based on a cross-sectional audit of 155 hospitals showing that two-thirdsof the hospitals surveyed do not have regular multidis-ciplinary team (MDT) meetings.1 In those that do, <1%of meetings are attended by the tumor-specific minimumcore team. At first glance these results seem very con-cerning. However, we are concerned that the surveymethodology may have produced misleading results.

The audit was done by random sampling of hospi-tals across Australia, using three different survey tools,because similar projects were underway in several dif-ferent states. Most responses (53%) came from theNational Breast and Ovarian Cancer Centre (NBOCC)survey that occurred in states other than Victoria andNew South Wales, where separate surveys occurred. Theauthors report that although a random sampling framewas developed, large metropolitan teaching hospitalswere underrepresented in the NBOCC sample. This isclearly a major flaw as most anti-cancer treatment plan-ning occurs at large metropolitan hospitals. Althoughthe authors acknowledge this deficiency it may be over-looked by those who read only the abstract.

In addition, the results may have been affected bya fundamental misunderstanding of what constitutesan MDT meeting. The NBOCC and New South Walessurveys defined MDT meetings as being “for thepurpose of treatment planning”, but no definition wasgiven in the Victorian survey.2 However it may not havebeen clear to respondents, who were mostly nursing staff(69%), that the meetings of relevance were actuallyMDT meetings, which are convened for planning anti-cancer treatment, as opposed to other types of meetingsthat form part of multidisciplinary care, such as unit ordischarge planning meetings.3

These limitations may potentially explain resultssuch as the Victorian sample reporting five gynecologymeetings, with only one in five regularly attended bya gyne-oncologist. Yet a personal survey of radiationoncologists who attend the five major gyne-oncologyMDT meetings in Victoria that consider anti-cancertreatment options (at the Mercy, Royal Women’s,

Peter MacCallum, Monash and Melbourne Pathology)indicates that all are routinely attended by multiplegyne-oncologists.

A further concern is that the NBOCC definition ofwhat constitutes a core team attending an MDT meetingalways includes the general practitioner (GP).4 Althoughthis may be preferred, in the real world it is neitherpractical nor desired by a busy GP. This is reflected inthe results that show poor GP attendance. While weagree that it is essential that MDT meeting outcomes arecommunicated to the GP, we do not believe the GPshould be listed as an essential member of a core teamrequired to attend meetings when it is highly unlikelythat a metropolitan GP would have more than onepatient presented at a meeting.

Models of multidisciplinary care need to be adaptableto work across different health care services rather thanfollow a one size fits all formula. We welcome furtherdiscussion about these issues and look forward to futureresearch into the quality of management of cancerpatients, of which the MDT meeting is an importantcomponent.

Dr Linda MILESHKIN andProfessor John ZALCBERG

Division of Cancer Medicine, Peter MacCallumCancer Centre, Melbourne, Victoria, Australia

REFERENCES

1 Wilcoxon H, Luxford K, Saunders C, Peterson J, Zorbas H.Multidisciplinary cancer care in Australia: a national audithighlights gaps in care and medico-legal risk for clinicians.Asia Pac J Clin Oncol 2011; 71: 34–40.

2 National Breast and Ovarian Cancer Centre 2008. Multi-disciplinary Cancer Care in Australia: A National Audit2006. National Breast Cancer and Ovarian Centre, Camp-erdown NSW 2006.

3 Mileshkin L, Zalcberg J. The multidisciplinary managementof patients with cancer. Ann Oncol 2006; 17: 1337–8.

4 National Breast Cancer Centre. Multidisciplinary Meetingsfor Cancer Care: A Guide for Health Service Providers.National Breast Cancer Centre, Camperdown NSW 2005.

Asia–Pacific Journal of Clinical Oncology 2011; 7: 317 doi:10.1111/j.1743-7563.2011.01429.x

© 2011 Blackwell Publishing Asia Pty Ltd