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Carers Interdependency

The cancer patient would like to believe that all of the members of the care team (physicians, nurses, scientists) work together to solve his/her health problem. Those who are ill do not understand school disputes, professional pride, personal animosities and group predilections.

Fortunately, oncologists and other carers are human beings and not robots. The energy lost in their disputes and pettifoggery is minor compared to the immense combined efforts for improving each and every patient’s treatment.

The cornerstone of a successful multidisciplinary dialogue is humility. No physician, no nurse has so much experienced that he/she can solve, alone, the cancer patient’s many and varied problems. There is no best radiologist, endoscopist, pathologist, surgeon, radiotherapist or medical oncologist, even after long years of practice.

We should therefeor accept our mutual interdependency.

Multidisciplinary discussion

It is of great importance to work with colleagues that we consider with trust and professional friendship.

Many failures to obtain efficient multidisciplinary work often stem from personal conflicts rather than from intellectual disagreements. In the heat of a discussion, emotional preferences should not override a calm attitude based on commonly scientific reasoning.

Excellent knowledge of recent literature, the retrospective common study of medical records and the drafting of scientifically based protocols, over and above the patient’s immediate needs, are the best ways to offer the most reasonable attitude, and not some sort of fate decided by the door through which the patient enters the cancer centre.

In the absence of irrefutable literature data, personal opinions may vary considerably. Ethical medicine should involve a scientific approach through inclusion in trials and cooperative groups.

Practising a multidisciplinary approach

The multidisciplinary dialogue should take place before any therapy has been performed. A radiotherapist or a medical oncologist may be more efficient if he/she has had the opportunity to examine the patient before surgery, even if surgery is the mandatory first therapy. On the contrary, neo-adjuvant radiotherapy or chemotherapy should not be given before the surgeon has examined the patient and evaluated the improvement induced by such treatment modalities.

Furthermore, by examining the same patient, before any treatment, the various specialists will learn to talk the same language and to imprive their own understanding of the intellectual and psychological motives of other carers. Cooperative follow-up will also enable improved comprehension of the benefits obtained through other therapies.

There are very few absolute truths in cancer treatment, therefore many opinions can be expressed. Every treatment type offers possibilities.

One of the most appropriate analogies is the symphonic orchestra: every instrument should perfectly perform its partition but play in harmony with the other instruments. It cannot prolong a note or play alone in cacophony, without leadership and direction. The analogy can be extended to the conductor, compared to the general practitioner or the mediator oncologist, who conducts but produces no sound. The aim of the whole orchestral team should be to delight the audience.

The regional oncology network.

Better understanding of the multidisciplinary approach and its evident benefit for the patient have led the French health authorities to oblige carers within the same region to coordinate their medical practice.

Whatever the physician’s practice mode and his/her work place, each patient should be offered the same chances adapted to his/her disease after previous multidisciplinary discussion implying all of the required specialists.

Therefore, weekly multidisciplinary meetings have been instituted in the various hospitals and clinics in coordination with specialised reference cancer centres.

Protocol drafting (in accordance with local possibilities and transfer to other regions) as well as treatment evaluation constitute the main missions of these regional networks.

All of theses changes are part of the French Cancer Plan adopted by the French President in 2002. Most other European countries have simultaneously elaborated comparable national programs.