Dr Francois Malherbe speaks about the team approach to fighting breast cancer

Breast and Endocrine surgeon, Dr Francois Malherbe describes the role and benefit of multidisciplinary care in breast cancer treatment.

What is a multidisciplinary team approach?

Patients with breast cancer are cared for by a team of healthcare professionals, each with their own expertise working together to deliver comprehensive patient care. This is known as a multidisciplinary team (MDT). They will meet regularly to discuss their patients care at the multidisciplinary team meeting (MDM). As a patient’s condition changes over time, the team’s composition may change to reflect the changing clinical and psychosocial needs of the patient.

The advantages are numerous: when patient information is reviewed by multiple professionals with different knowledge and experience fields, accuracy in diagnosis is higher, and patient outcomes are generally improved.

Why the need for a multidisciplinary team?

Breast cancer is the most common cancer affecting women worldwide, including South Africa. In South Africa, women have a 1 in 27 chance of developing breast cancer during their lifetime. This is less than in developed countries, probably due to incomplete statistics rather than a true lower incidence. Therefore, because breast cancer is so common, research into breast cancer is far more advanced compared to other types of cancer affecting women. We have managed to identify different types of breast cancer that all might have slightly different treatment plans. There are also tests available to look at genetic mutations within breast cancers that guide treatment. Tests that look at genetic mutations in a patient’s DNA like BRCA genes that increase your risk for developing breast cancer, are much cheaper and easier to perform. These tests are often performed earlier on the advice of the MDT. Traditionally, women had surgery after breast cancer diagnosis followed by chemotherapy, radiotherapy, and hormonal treatment. Now many women would benefit from chemotherapy before their surgery. The optimal management of patients with breast cancer requires the expertise of specialists from different disciplines. Allowing all key professionals to jointly discuss individual patients and contribute independently to clinical decisions is crucial to achieving the best result. Every patient is different, and an individualised treatment plan rather than a one size fits all approach has been shown to improve outcomes in breast cancer.

Who is part of an MDT?

Typically, the minimum number of MDT members would be a breast surgeon, clinical oncologist, radiologist, pathologist, and plastic surgeon. Many MDTs have varying numbers of other team members like phycologists, genetic counsellors, fertility specialists, breast care nurses, lymphedema specialists, physiotherapists, social workers, and palliative care physicians. Breast cancer treatment often involves many of these specialties, and because multiple opinions are available early in the treatment, problems are often identified and addressed earlier, which is of huge benefit to the patient.

When do MDT meetings occur?

An MDT meeting often happens early on, as soon as enough information is available to know the stage of cancer. An initial treatment plan can be formulated, discussed, and feedback can be provided to the patient at this stage. Patients can be re-discussed at any stage, particularly when something unexpected changes in their treatment.

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