Multidisciplinary cancer clinics: Their time has come

Advances in the evaluation and treatment options for patients with a malignancy are increasing at an ever faster pace. Today’s clinician is faced with a variety of methods to image tumors, biopsy masses, and stage cancers. Even more complex can be deciding upon the choice of treatment. Neoadjuvant therapy, regional therapy, organ preservation, limb salvage, tissue reconstruction, postoperative adjuvant chemotherapy, biotherapy, and radiation therapy represent examples of multimodal approaches to cancer care. Unlike what existed 10 years ago, there is an increasing array of multimodal therapies to offer the individual cancer patient. Not only is this obvious to the clinician, it is also apparent to patients. With the availability of the Internet, patients have access to enormous amounts of medical information. Most of the time, they do not have the necessary background to evaluate this information, which makes them confused and more inquisitive. This increasingly sophisticated patient population has higher expectations from the medical establishment and is attracted to multidisciplinary clinics to seek information and care. What constitutes a multidisciplinary clinic varies from place to place. At our institution, we envision a multidisciplinary cancer clinic as providing ‘‘one-stop shopping’’ for the patient. In other words, patients come to one outpatient clinic and are seen by the appropriate caregivers from the various disciplines in the same clinic on the same day. Patients are not shuffled from one clinic to another in order to get input from the various disciplines. The focus of these ‘‘intake’’ clinics is to evaluate the newly diagnosed cancer patient or individual with a lesion highly suspicious for malignancy. The subsequent follow-up of these patients after treatment recommendations are made is conducted in clinics associated with the individual disciplines involved with the care of the patient. We have established several multidisciplinary clinics at our institution, which are either diseaseor organspecific. Examples of disease-specific clinics include our Multidisciplinary Melanoma and Lymphoma clinics. Examples of organ-specific clinics include the Head and Neck Oncology Clinic and the Breast Care Center (BCC). The latter involves a clinic to evaluate undiagnosed breast problems as well as newly diagnosed breast cancers. There are certain organizational elements which are critical to the success of a multidisciplinary clinic. These include a physician-director, nurse coordinator, administrator, support staff, members from the clinical disciplines including pathology and radiology, and a tumor board. The ability to have a tumor board convene on the same day of the clinic visit provides timely feedback of information to the patient. Alternatively, if patient evaluations require more detailed review by pathologists or radiologists, a tumor board can be convened on an alternate day and the recommendations subsequently conveyed to the patient. Patient satisfaction associated with either multidisciplinary clinic format is high, as measured by growth in patient activity. In Figure 1, the number of new breast cancer patients seen in our BCC is graphically depicted and demonstrates a dramatic increase over time. We have found that our current constraint on seeing more patients was due to the limited number of caregivers available to staff the clinic. In 1992, there was a radio advertisement campaign that recruited a considerable influx of patients to this clinic, which overburdened the clinic staff and had to be discontinued. Figure 2 illustrates the increased patient activity observed in the Multidisciplinary Melanoma Clinic since its inception. This clinic represents one of the most active melanoma clinics in the United States. An intuitive reason to develop multidisciplinary clin-