The Importance of A Multidisciplinary Team

Today I was privilaged to see how a multidisciplinary team works together in decision making. I followed a close family member as he navigated the first office visits for suspected cancer. The team of specialists ranged from pulmonary medicine, thoracic surgery, radiation oncology and medical oncology.

The pulmonary medicine specialist was most concerned with a pulmonary co-morbidity and how this would play a major part in the health of the patient over the next twenty four months. He was not as concerned about the suspicious lung nodule that was an incidental finding on X-ray, feeling strongly that it was not as pressing as the immediate condition of worsening COPD.
Recommendation, wait a month and repeat CT scan. Antibiotic to combat residual pneumonia in the lungs.

The thoracic surgeon's opinion mirrored pulmonary medicine, with the addition of stressing that the test results were still inconclusive as to the diagnosis of the nodule. Recommendation was to wait for a month, repeat CT scan and look to see if the nodule had changed in size. General opinion would lead to the belief that this nodule probably was not cancer and even if it was, would be slow growing due to a PET scan that indicated limited uptake of contrast. Uptake by the lymph nodes was thought to be due to infection and/or inflammation.

Radiation Oncology was VERY different, with recommendation that a lymph node biopsy be conducted. Discussion centered on some uptake at the subcarinal and hilar lymph nodes. Biopsy of these nodes would not compromise the patient and could be done for definitive diagnosis. Assessment by this professional leaned more towards a cancer diagnosis and evaluation for staging the patient so that a treatment plan could be formulated. Extensive discussion focused on treatment options for various stages should the biopsy be negative or reveal cancer spread to lymph nodes.

The radiation oncologist explained that this case would be included in a tumor board discussion that would include all physicians involved with the case, as well as others with similiar knowledge and experience. After presentation of this case, the radiation oncologist would share the tumor board concensus with the patient.

From this experience, I got to witness the various thought processes, analysis and conclusions that each physician went through in an individualized setting. It was surprising to see the varying degree of importance and urgency each placed on the possiblity of a cancer diagnosis. It was also very encouraging to hear that each one will come to the table and as a team work together to provide the very best possible care in a difficult and challenging situation.