Lung Cancer

The Team Approach to Your Care
. . .an Interview with Paul A. Bunn, MD

What is multidisciplinary care?

Multidisciplinary care is treatment that is planned and delivered by a group of different specialists, all dedicated to providing optimal care to a person with lung cancer. You may have different types of doctors on your multidisciplinary care team, depending on the stage of your cancer and your treatment options, but a team typically includes:

  • Medical oncologist – a doctor who treats cancer with medicines such as chemotherapy
  • Thoracic surgeon – a doctor who treats diseases of the lungs and chest with surgery
  • Radiation oncologist – a doctor who treats cancer with radiation therapy
  • Pulmonologist – a doctor who specializes in the medical treatment of diseases of the lungs
  • Pathologist – a doctor who specializes in determining the cause of cancer and other diseases
  • Radiologist – a doctor who interprets X-rays and scans

Many other specialists may be involved in your care as well, including nurse practitioners, nurses, respiratory therapists, social workers and other health professionals.

Why is a multidisciplinary care team necessary?

There are many options for treating lung cancer – drugs, radiation and surgery – and most people with lung cancer receive more than one type of treatment. The order in which the treatments are given is also important. The complexity of selecting the appropriate treatment plan for a person with lung cancer requires a team effort. In academic medical centers, the team generally meets once a week to discuss the cases of individual patients. Physicians in private practice often turn to tumor boards at local hospitals to benefit from the expertise of a multidisciplinary care team.

Is multidisciplinary care new?

No, multidisciplinary care has been around for a while. The International Association for the Study of Lung Cancer (IASLC) was established in the early 1970s as a multidisciplinary organization. We wanted one association for all the people involved in the prevention, diagnosis and treatment of lung cancer. Over the past 40 years, research has confirmed that standard treatment of Stage I, II and III lung cancer involves more than one modality, or type of treatment; this is known as multimodality treatment.

What is new, however, is the increasing importance of the pathologist. The pathologist’s role on the team has always been crucial—there are four histologic types of lung cancer, and treatment depends on knowing the histology. But now, molecular features of the tumor are becoming a factor in treatment decision-making, and the pathologist must interpret the results of those tests as well. Sometimes it’s the same pathologist looking at histology and molecular features and sometimes there’s a molecular pathologist assisting.

What is the main benefit of a multidisciplinary care team?

The key is to get the prognosis and treatment correct from the start, and that means making an accurate diagnosis and assigning the correct stage. Determining the stage often requires the collaboration of several different specialists. For example, a radiologist interprets imaging studies. A pulmonologist, surgeon and interventional radiologist may work together to ensure that a biopsy specimen is obtained in the safest way possible by the physician with the most expertise with the chosen procedure. A pathologist may think that additional tissue is needed in order to make an accurate diagnosis. What it comes down to is this: Research has shown that when you have the right pathology, the right diagnosis, and the right stage, outcomes are better. And when multimodality treatment is used, survival rates are better.

If a multidisciplinary treatment team is not readily available, what should I do?

If a person with lung cancer lives in an area that’s far from a major medical center, it is reasonable to suggest getting a second opinion on the diagnosis, staging and treatment plan. A second opinion can be very useful and can provide guidance to a local physician. Most treatment can be given locally, and the goal in these situations is to deliver as much care as possible close to home.

 

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