Information presented heretofore in this chapter can be summarized as follows:
The knowledge base necessary to provide state-of-the-art cancer care is extensive.
The cancer treatment literature resides in journals specific to several different medical specialties, and no single physician is likely to be familiar with all aspects of this scientific evidence.
A familiarity with active clinical trials and emerging scientific data for each type of cancer is needed.
Physicians from different cancer-related specialties often have divergent opinions concerning cancer treatment and prognosis.
For most major types of malignancy, some treatment recommendations are established as standard care whereas many others remain controversial.
Although data are not available to quantify the extent to which physicians involved in cancer care adhere to standard treatment recommendations, studies pertaining to several other fields of medicine suggest that compliance may be suboptimal.
When emerging medical knowledge is presented to physicians in a didactic fashion, they are slow to integrate such information into their patterns of practice.
The mere dissemination of treatment guidelines to physicians does not alter their treatment decisions.
To alter physician practice patterns, necessary steps include interactive learning, engagement of physicians in the process of guideline development, involvement of "thought leaders," and provision of ongoing outcomes data.
If one accepts these conclusions, then the need for a collaborative approach to cancer care is clear. When physicians from multiple cancer-related specialties meet to discuss new cancer patients and to prospectively plan the optimal treatment plan, several important events occur.
1. Specialty-specific knowledge is shared among participating physicians.
2. New information from the medical literature possessed by any member of the group is shared and likely integrated into the treatment planning process.
3. Disagreements among specialists are discussed until a unified opinion is formulated, thus providing the patient with clear and consistent information.
4. Locally applicable treatment guidelines are developed by participating physicians. The fact of their involvement in the process increases the likelihood of adherence.
5. The interdisciplinary team is an ideal forum for the identification of key outcome measures. These same physicians can review the data and modify the process of treatment as needed; this constitutes a total quality management cycle.117
6. Medical institutions involved in clinical research can utilize these meetings to determine patient eligibility for clinical trials and to inform the treating physicians accordingly.
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