Oncology Teamwork
Authors: Harold J. Burstein
Journal: Journal of the National Comprehensive Cancer Network (2008)

A unique hallmark of comprehensive cancer care is treatment delivered in well-organized teams.Most comprehensive cancer centers organize care around multidisciplinary provider teams that center on the disease rather than the training or professional background of the providers.Most oncology patients can identify multiple clinicians who are part of their cancer care team.Most guidelines in oncology, and certainly the NCCN Clinical Practice Guidelines in Oncology, invariably describe integrated, multidisciplinary management.The number of sub-specialists involved in caring for a single patient can be legion: surgical, radiation, and medical oncologists; radiologists; pathologists; pain or palliative care specialists; geneticists; psychologists, social workers, and counselors; oncology-specialized treatment and symptom-control nurses, nurse practitioners, and physician assistants.A patient with newly diagnosed cancer who is embarking on a multidisciplinary treatment program might encounter literally dozens of health care providers-each with his or her own business card, email address, and pager number-who will weigh in on the treatment plan and goals.Further, all these clinicians must communicate with each other and work together to deliver the type of seamless care that patients deserve.Sometimes the entire cancer care team works in the same building at a single institution; other times, the members may be joined in a loose confederation or work at entirely different cancer clinics.This brings up many questions.How are teams created and sustained?How is communication facilitated and enhanced?Although easily recognized as an important goal in cancer care, the fully integrated team of cancer specialists is not an easy creation.Medical training tends to be intradisciplinary-surgeons are trained to operate, radiation oncologists to deliver radiation, and medical oncologists to administer chemotherapy.Hospitals are historically organized into separate divisions of medicine and surgery, with radiology, pathology, and other clinical services further separated as unique departments.Some cancer centers share health information systems, but cancer care often cuts across offices, hospitals, and clinics that do not have integrated technology.That creates practical challenges in retrieving clinic notes, radiology reports, and pathology reviews, and in scheduling appointments.Because integrated care really can improve cancer outcomes, it is imperative to study and more successfully understand the strategies for creating and managing teams of cancer care providers.For example, how should we train cancer specialists to work in teams when they are educated to work more individually?What is the optimal staffing for multidisciplinary clinics?What information systems are needed?How should patient flow through clinics be encouraged?Which providers should handle which aspects of patient education?How many specialists should see patients during follow-up or survivorship surveillance?Which oncologists speak for the "team?"These are all practical and daily challenges.Guidelines like those from the NCCN address innumerable details in treatment management based on clinical features of cancer, but infrequently speak to the challenge of actually delivering that care.However, leading cancer centers such as the NCCN member institutions have substantial experience in building cancer treatment teams.Our leading cancer centers have much to share from their experience in creating outstanding cancer treatment teams, and we hope that JNCCN-The Journal of the National Comprehensive Cancer Network can serve as an emerging forum for these discussions.