Understanding the role of advanced bowel cancer Multidisciplinary Teams (MDTs)
Wednesday 27 September 2017
Written by Stephen Fenwick
When bowel cancer spreads from the bowel to other parts of the body, most commonly the liver and lungs, we call it advanced bowel cancer. Every year around 10,000 people are diagnosed with advanced bowel cancer. Sadly only about one in ten of them will survive beyond five years, and many will have to live with the consequences of the disease and treatment which can reduce their quality of life.
However we do have opportunities to improve survival rates and quality of life for people with advanced bowel cancer, but only if they have access to the best treatment and care. This is where an advanced bowel cancer multidisciplinary team can help.
What is an advanced bowel cancer Multidisciplinary Team (MDT)?
Typically, before cancer patients undergo treatment, they are reviewed by an MDT specific to the type of cancer they have – bowel MDT for bowel cancer, liver MDT for liver cancer – and the MDT decides on the best course of treatment.
These teams are made up of healthcare professionals, all with specialities relevant to the site of the cancer. These teams are very good at planning effective treatments for patients whose cancer is limited to one organ, such as the bowel.
However in cases where bowel cancer has spread to other parts of the body such as the liver or lungs, we believe patients would significantly benefit from the input and advice of MDTs that specialise in treating advanced bowel cancer.
An advanced bowel cancer MDT is made up of specialists who have the range of expertise needed to effectively manage and treat every aspect of advanced bowel cancer, at whichever site it is found. This includes:
- Bowel, liver, and lung surgeons to decide and carry out the best course of surgery wherever the tumour is located;
- Oncologists with expertise in chemotherapy and radiotherapy to plan and deliver treatments;
- Radiologists capable of providing accurate imaging for tumour staging, as well as carrying out ablative and embolic therapies to treat tumours;
- Clinical nurse specialists to communicate outcomes and options from advanced bowel MDT meetings to patients, and provide high-quality information, support, and care throughout their treatment.
By combining these and other applicable specialists into one team, an advanced bowel cancer MDT can come to well informed decisions quickly and provide patients with the most effective treatment options. This increases patient chances of quality survival.
Why are advanced bowel cancer MDTs important?
We know many advanced bowel cancer patients do not have their case reviewed by MDTs best suited to deal with advanced bowel cancer. Sadly this results in patients not being offered surgery or other treatments that could save or prolong their lives.
Some years ago I carried out research that shows the devastating impact this can have on patients with advanced bowel cancer that had spread to their liver. We found that not involving liver specialists in the treatment decision of patients with advanced bowel cancer involving the liver denied many patients the chance of surgery which could have cured their disease. Instead they were placed on a palliative treatment pathway.
This is why an advanced bowel cancer MDT is so important in delivering the best treatment for patients, because it provides one central point where patients can be referred, assessed, and given the best treatment options.
How can we increase advanced bowel cancer MDT working?
Currently, advanced bowel cancer MDTs are not standard practice in the NHS. At Aintree University Hospital in Liverpool, our team established the first advanced bowel cancer MDT in the UK in 2012. We provide a central referral point for all patients with advanced bowel cancer in Cheshire and Merseyside, North Wales and the Isle of Man.
To deliver the best for patients we need to implement and formalise the advanced bowel cancer MDT model more widely across the country. This will require interested and experienced clinicians working together to develop such services across the UK, as well as investment and backing from the NHS to ensure consistent adoption of this model.
Right now, health professionals are dealing with more people than ever before, and resources are stretched. However experienced specialists must take proactive steps to come together and develop such services – most likely on a regional basis.
What is the future for advanced bowel cancer MDTs?
This is an incredibly exciting time for those managing and treating patients with advanced bowel cancer.
We are in a period of development, with more treatments and technologies becoming available, enabling us to treat the disease more effectively. Furthermore our understanding of the biology of bowel cancer is improving. Ultimately, with further research we could better understand how a cancer behaves in a specific patient. Understanding this would allow doctors to use treatments which are likely to have the most benefit, and avoid using those which will not help and only expose the patient to the risk of harm from the side effects. This is called ‘personalised medicine’ and I am sure this will become the reality for advanced bowel cancer patients.
I am sure this ‘personalisation’ in treatment is the future for advanced bowel cancer management, and the mixture of skills available through advanced bowel cancer MDTs will be vital to ensure patients gain the most benefit.