Cancer MDT Barriers: Lessons Learned Along the Way
By Dr Amar S Bhogal and Professor Kevin Moore
Working as a doctor in the NHS, I have seen firsthand the vital role that the cancer multidisciplinary team (MDT) plays in delivering high-quality, patient-centred care. The MDT is globally recognised as the gold standard for cancer treatment planning, allowing specialists from different disciplines to collaborate and navigate the complexities of cancer care together. However, one of the key observations I’ve made in these meetings is the imbalance in contributions—medical professionals, particularly consultants, often dominate discussions, while other essential team members, such as specialist nurses and MDT coordinators, contribute less frequently (Jalil et al., 2012; Rosell et al., 2018). Yet, these individuals are the backbone of the MDT, ensuring logistical efficiency, gathering comprehensive patient data, and facilitating seamless coordination of care. Without their insights, key details can be overlooked, and the efficiency of decision-making can be compromised.
Beyond the clinical benefits of MDT discussions, their value extends to training junior colleagues, adhering to updated guidelines, considering patient preferences, and promoting clinical trial recruitment. At the same time, MDT panels often face challenges in decision-making and sometimes require multiple meetings to reach a conclusion. These delays compromise patient care and impose additional burdens on panel members. Studies indicate that 4–15% of MDT recommendations are not implemented into care (Jalil et al., 2013), a costly inefficiency both for patients and healthcare systems given the average cost of £415 per new patient in an MDT (De Ieso et al., 2013).
Addressing Inefficiencies in MDTs
To enhance MDT functionality and prepare for future demands, it is essential to identify and address the factors contributing to their inefficiencies. Research highlights several barriers to effective decision-making in MDTs (Figure 1). It identifies common themes across cancer specialities and countries:
Need for Supplementary Investigations: The lack of required imaging or diagnostic tests was the most frequently cited barrier.
Non-Attendance of Key Personnel: The absence of essential team members disrupts decision-making.
Insufficient Information on Patient Co-Morbidities: Without a comprehensive understanding of a patient’s health status, treatment plans may be suboptimal.
What blocks effective decision-making in MDTs?
Figure 1
These barriers underscore the critical need for systems that streamline the collection and availability of essential data, such as investigations and co-morbid information. Software technology can help teams better prepare cases and open the accessibility of these resources to significantly reduce delays, decrease rollover cases, and alleviate time pressures on clinical staff.
What to do? Optimise MDTs
The MDT remains a cornerstone of cancer management and must evolve to meet growing demands. By addressing key inefficiencies, such as improving data availability and ensuring full panel participation, MDTs can function more effectively to provide timely and high-quality care for cancer patients. Investments in technologies and streamlined workflows will not only save time and resources but also enhance patient outcomes.
References
De Ieso, P. B. et al. (2013) ‘A study of the decision outcomes and financial costs of multidisciplinary team meetings (MDMs) in oncology’, British Journal of Cancer. Nature Publishing Group, 109(9), pp. 2295–2300. doi: 10.1038/bjc.2013.586.
Jalil, R. et al. (2012) ‘The cancer multi-disciplinary team from the co-ordinators’ perspective: Results from a national survey in the UK’, BMC Health Services Research, 12(1). doi: 10.1186/1472-6963-12-457.
Jalil, R. et al. (2013) ‘Factors that can make an impact on decision-making and decision implementation in cancer multidisciplinary teams: An interview study of the provider perspective’, International Journal of Surgery. Elsevier, 11(5), pp. 389–394. doi: 10.1016/j.ijsu.2013.02.026.
Rosell, L. et al. (2018) ‘Benefits, barriers and opinions on multidisciplinary team meetings: A survey in Swedish cancer care’, BMC Health Services Research. BMC Health Services Research, 18(1), pp. 1–10. doi: 10.1186/s12913-018-2990-4.
About the Authors
Dr. Amar S. Bhogal is a junior doctor in the United Kingdom, dedicated to enhancing patient outcomes through the integration of advanced healthcare technologies. He has a robust background in medical research, having served as a Research Assistant at University College London's Institute for Liver and Digestive Health. His work has been pivotal in exploring the application of remote technology to support acute inpatient and transitional care, particularly for individuals with chronic obstructive pulmonary disease (COPD).
Beyond clinical medicine, Dr. Bhogal has held leadership roles in both the publishing and education sectors. He worked with Elsevier as a commissioning and managing editor for oncology journals, playing a key role in curating and advancing high-impact scientific research. Additionally, he served as a director for an educational startup focused on supporting children from disadvantaged backgrounds, demonstrating his commitment to widening access to education and fostering opportunities for young learners.
Passionate about the transformative potential of healthcare technologies, Dr. Bhogal is focused on leveraging innovative solutions to improve clinical practices and patient care.
Dr. Kevin Moore is a Liver Expert for the Courts, where he provides an independent opinion on the care provided by other doctors. As a Professor of Hepatology and Clinical Pharmacologist at University College London, his expertise in drug safety monitoring and adherence to national guidelines provides a unique perspective on the healthcare system's successes and failures. With over two decades of specialized experience in liver transplantation and general hepatology, he brings substantial clinical and academic authority to both patient care and medical-legal evaluations, along with a keen understanding of the practical challenges facing modern healthcare delivery.
Kevin Moore at UCL, Royal Free has authored over 100 research papers with an H index of 64 and is the author of the Oxford Handbook of Acute Medicine.
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