February 2014, Vol 3, No 1
The Importance of the Multidisciplinary Team in Personalizing CareLetter to Our Readers
One of the things that sets oncology care apart from the care of other illnesses is the necessity for the patient to be under the care of a multidisciplinary team. A patient with a cardiac issue may be managed just fine by a cardiologist. A patient diagnosed with cancer, however, requires a multidisciplinary team working together to provide the necessary diagnostic tests, treatment planning, and coordination of care in keeping with specific standards of care in order for the patient to receive the right care, in the right setting, by the right providers.
The first team members to come to mind are the surgical oncologist, medical oncologist, radiation oncologist, radiologist, cancer rehabilitation therapist, and pathologist. However, there are other important team members: the nurse navigator, the social worker, oncology nurses, technicians, the chaplain, the palliative care team, and others who help to further address the patient’s personal needs, which include physical, emotional, financial, cultural, educational, psychosocial, as well as spiritual needs. This means that at any given time, any one of these professionals referenced above is the most important person to the patient in that moment.
Each of us has a pivotal role to carry out on behalf of the patient. Collectively, however, we have the opportunity to truly provide personalized care that goes well beyond the patient’s pathology and staging workup results. We are treating a person who is 35 years old, is an elementary school teacher who has a 9-year-old son with autism, is scraping by financially because her husband has been laid off, and she has just been diagnosed with stage 2a breast cancer. All of these considerations need to be factored into the patient’s treatment planning, including her future life goals. For example, she and her husband hope to have another child once he gains employment. One of her greatest joys is playing the piano. Having the multidisciplinary team know these additional things about her helps the team collectively plan her treatment, beginning with fertility preservation, cancer prehabilitation to prevent deconditioning instead of having to recondition her later, and to be cautious when considering what therapies to use so that a side effect like peripheral neuropathy can be avoided.
How does this all come together? That is one of the challenges I want us all to take on, beginning now – really knowing our patients, keeping them on track for their life goals, and maintaining joy in their lives, so that personalized care really is personalized. We should include in tumor board discussions all of this information referenced above as well as revisit the patient’s status after her treatment is done so the team can hear that this patient is back teaching school, pregnant, and playing the piano.
So join me in ensuring that personalized medicine and personalized care unite. Our patients deserve it, and our professional (and personal) lives are all the more enriched as a result.
Lillie D. Shockney, RN, BS, MAS
Johns Hopkins Medicine
PMO Board Member
Adjuvant Bisphosphonates: Winner in Postmenopausal Breast Cancer Adjuvant bisphosphonates reduce the risk of bone metastases by about one-third and improve breast cancer–related survival by 17% in postmenopausal women with early breast cancer, according to a large meta-analysis reported here. Bisphosphonates had no effect on premenopausal women in the adjuvant setting. [ Read More ]
Obinutuzumab, a novel, glycoengineered, type II CD20 antibody, in combination with chlorambucil was superior to rituximab plus chlorambucil in prolonging progression-free survival (PFS) in previously untreated patients with chronic lymphocytic leukemia (CLL) with comorbidities. Treatment with obinutuzumab also led to a significantly higher objective response rate, and more patients treated [ Read More ]