20 Years of Cancer ‘War Room’ at Sydney Adventist Hospital – improving outcomes and patients’ experience

When you hear the words ‘You have cancer’, your world as you’ve known it changes in a myriad of ways. Imagine how reassuring it would be to know you have the benefit of not only one skilled specialist, but also the input from a team of 15-20 health professionals – all experts in various aspect of cancer care – who voluntarily invest their time to give you the best outcome and support.

At Sydney Adventist Hospital (the San) these teams are called multidisciplinary teams. There are 11 of these teams for 11 different cancer streams. Multidisciplinary teams (MDTs) meet regularly to donate their skills and experience towards your particularly unique cancer journey; from diagnosis, to treatment, to recovery and survivorship.

The San was one of the early adopters of the concept of MDTs, holding its first multidisciplinary team meeting 20 years ago. The Breast MDT was the first, followed closely by other cancer streams.

“In these MDT meetings, clinicians review the diagnostic information, the clinical presentation and the relevant medical and psychosocial issues. We discuss different viewpoints and the most up-to-date research, clinical trials, and evidence-based treatment approaches,” said Professor Michael Hughes, Surgical Oncologist and Chair of Breast MDT at the San. “The person’s treating clinician then takes the recommendations from the MDT to the patient for discussion, and the patient is involved in the final decision-making process. This way the patient can benefit from the input of multiple specialists – at no extra cost – and without having to go from one doctor to another.”

“We believe that through the MDTs we have a system that is not only delivering the best care, it is also inclusive of the patient in decisions about their care,” added Prof Hughes. “This approach focuses on the whole individual and demonstrates empathy for our patients and their families.”

Cancer ‘war room’

At the San, multidisciplinary teams meet in a purpose-built mini-auditorium, filled with high-definition big screens, people smarts and tech smarts – not unlike the war rooms you see in movies. It is encouraging for patients to know that while they face treatment, there are dozens of people behind the scenes who are giving their best towards each patient’s care. 

“The multidisciplinary team meetings include surgeons, medical oncologists, radiation oncologists, pathology, imaging/radiology, cancer nurse-navigators and allied health,” said Clinical Professor Gavin Marx, Medical Oncologist and Director of the San Integrated Cancer Centre. “The MDT facilitates a very smooth transition across the specialties for each patient. It is also a great quality-assurance process, which patients appreciate.”

Radiation Oncologist, Professor John Boyages AM, concurs. “MDTs are a real safety net, and that is important. If you’re worried about something with one of your patients, you can bring it to the whole group. Patients appreciate that.”

MDT teams donate hundreds of hours of their time to attend MDT meetings, which start at 7am – before their workday begins. Some specialists attend six MDT meetings each fortnight – for different cancer streams.

Professor Hughes notes there are very rapid changes in cancer management these days. “The sharing of knowledge in the MDTs means we’re always modifying and improving our practise based on the latest evidence available. Patients benefit from this.”

Gold standard in cancer care

The MDT meetings have come a long way since they were first introduced at the San in 2005. In those days multidisciplinary teams met in the hospital boardroom, with paper copies of everything, and x-ray films viewed on a portable lightbox wheeled into the room. 

“In 2017, thanks to the exceptional generosity of the Gates family, a purpose-built, high-tech MDT facility opened at the San,” said Professor Marx. “This, combined with the development of a dedicated cancer information management system (funded through the San Foundation), took MDTs to the next level at the San.”

“The cancer information management system not only enhances timeliness, accuracy and the smooth running of the meetings, it provides data for research projects which, in turn, leads to continual improvements in cancer treatments and care for our patients.”

“The concept of multidisciplinary care is well recognised as the gold standard for optimising patient care in the cancer setting,” added Prof Marx. “We are very fortunate at the San; a hospital that is very supportive and provides good resources to make MDTs possible.”

Reducing the burden for patients

A cancer diagnosis can come with an avalanche of information. Too much information from too many sources too quickly can be overwhelming. The MDTs help to avoid this. “The San’s multidisciplinary teams are truly integrated, collegiate and respectful,” said Prof Boyages. “By working together, we review and visualise each patient’s imaging, nuclear studies, and histopathology in detail. This allows us to provide patients with a clear, coordinated treatment strategy without the ‘specialist ping-pong’ so common elsewhere. It’s teamwork at its very best, and patients and their families benefit.”

“We’re seeing an evolution in the way we treat cancers,” added Prof Boyages. “The MDTs are an integral part of the Integrated Cancer Centre approach to caring for our patients at the San. This involves a whole spectrum of expertise, and we’re not just focused on the period of active treatment, it’s also about picking up the pieces afterwards, which is important.”

Always looking to improve patient outcomes

There are 11 MDTs at the San including: Breast; Gastrointestinal; Neuro-oncology; Lung; Urology; Melanoma, Sarcoma, Head and Neck Cancer; Haematology; Endocrinology; Gynaecological Oncology; Prostate.

To take MDTs to the next level at the San, very accurate data is needed in order to measure outcomes and long-term follow-up. “The focus for the immediate future is to build the capacity for improved data management. This will enable the San’s multiple MDT cancer streams to collaborate with other centres in cancer research, and to contribute to national cancer data,” said Prof Marx. “This will require a combination of extra data-managers and optimising our cancer information system to enable the San to contribute to, and participate in, more research. This will provide even better outcomes for patients.”

A/Prof Stephen Pillinger, Chair of the Gastrointestinal MDT said MDT meetings are integral to cancer care, and that all cancers should be discussed at an MDT. “Multidisciplinary team meetings ensure cancer is managed not by one physician, but by a whole oncological team, providing clinical oversight and consistency. It gives patients reassurance that the latest research is taken into account; that all treatment options are considered until consensus is reached on the best pathway; and that cancer care is being conducted in the most thorough and up-to-date manner possible.”