Nathan Levitan Meri Armour and Afshin Dowlati

In recent decades, cancer treatment has evolved from a purely surgical approach to the complex coordination of sophisticated surgery, radiotherapy, and chemotherapy. The technology associated with pain and nutrition management has improved,1-3 and the importance of psychosocial factors in the treatment of cancer patients has been recog-nized.4 The knowledge base pertaining to cancer treatment has become so vast that many physicians have developed sub-specialty expertise in a focused aspect of cancer care. Quality of care analyses have indicated that the improved outcomes of certain cancer treatments occur when they are provided at high-volume facilities.5

One response to the challenges inherent in the provision of state-of-the-art cancer care has been the formal coordination of multiple disciplines in the planning and implementation of a treatment program. The American College of Surgeons, which certifies hospital-based cancer programs, requires the interaction of medical oncologists, radiation oncologists, and surgeons at prospective treatment planning conferences.6 Patient advocacy organizations such as the R.A. Bloch Cancer Foundation strongly advocate this approach to care as well.7

The interaction of multiple disciplines in cancer care has variably been referred to as multidisciplinary or interdisciplinary. In The Helper's Journal, Larson draws a distinction between these two terms. He defines multidisciplinary care as that which involves clinicians with multiple different areas of expertise, although not necessarily in a coordinated fashion. In contrast, he defines interdisciplinary care as the formal collaboration of these clinicians in each patient's treatment planning, "where the interaction of the team is necessary to produce the final product."8 Henceforth, we use the term interdisciplinary with the aforementioned intended meaning.

The purpose of this chapter is to review the scientific basis for and the logistic challenges involved in the delivery of interdisciplinary cancer care. Noting at the outset that currently there is a paucity of data in the medical literature pertaining to the impact of this type of care in comparison to conventional treatment, we explore closely related issues. The following questions are addressed: (1) How has cancer care evolved in recent years, and why is there a need for a coordinated approach to care? (2) Can cancer care be standardized on the basis of clinical trials outcomes, or must all treatment decisions be individualized? (3) How much variability exists in the delivery of cancer care, and when does this represent a lapse in quality? (4) How can physician behavior be modified to provide patients with the best care? (5) How does the establishment of an interdisciplinary treatment team increase the likelihood that uniform, high-quality, state-of-the-art cancer care will be delivered?

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

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