Delivering cancer services: a multi-disciplinary approach

The article by Lim [1] on the development of oncology services in Malaysia was both insightful and comprehensive. It is interesting to read that cancer services are growing from strength to strength, with a national cancer institute planned. The field of oncology has been transformed over the last few decades with a proliferation in technological advances and a revolution occurring in molecular medicine. Interestingly, the thinking surrounding cancer service delivery has also been changing. Cancer care is increasingly being delivered within a multidisciplinary team environment, involving a host of highly skilled professionals. As oncologists, despite our unique skills in the diagnosis and treatment of cancer [2] we are, but a cog (albeit a necessary one), in a big wheel that is required to manage this complex disease. Therefore, it is arguable that oncology might actually be considered a multidisciplinary specialty. Every oncology department relies on a team of highly trained radiographers, physicists, pharmacists, nurses, and support staff for everyday functioning. With the resurgence of radiation research and development, intensity modulated and image guided radiotherapy [3] being prime examples, our reliance on our physicist and radiographer colleagues has never been greater. This includes all aspects of radiotherapy delivery, machine commissioning, quality assurance, treatment planning, and research. It has also been recognized that cancer centres benefit from taking an active role in public education and outreach, as this often leads to drastic improvements in patient satisfaction and overall perceptions. The concept of teamwork extends far beyond our own departments. One of our inseparable partners is radiology, which has evolved into a vast and multifaceted discipline. Different forms of imaging are used during a patient's clinical course to diagnose, stage, plan, deliver intervention, and detect recurrence. Standard workhorses such as plain radiography and computed tomography (CT) are invaluable, but more specialized imaging is also important, including magnetic resonance imaging for detecting spinal cord lesions or imaging pelvic anatomy, bone scans for detecting skeletal metastases, and radiofrequency ablation for treating liver metastases. Even the most subtle of radiological features may predict a patient's outcome, for example, the presence of rectal tumour found within 1 mm of the mesorectal fascia on a T2 weighted MRI scan could signify a substantial increase in the chance of local recurrence and warrant aggressive downstaging by preoperative chemoradiotherapy [4]. An emergent technology is CT-positron emission tomography (CT-PET). It offers undeniably superior imaging quality and evidence of its efficacy is …