Update information

This guideline is an update of NICE cancer service guidance on improving outcomes in haematological cancers (published October 2003).

New recommendations have been added for the role of integrated diagnostic reporting and the staffing and levels of care needed to treat haematological cancer.

These are marked as:

  • [new 2016] if the evidence has been reviewed and the recommendation has been added or updated

  • [2016] if the evidence has been reviewed but no change has been made to the recommended action.

The NICE cancer service guidance on improving outcomes in haematological cancers (2003) was developed using very different methods to the current NICE guideline development process. The 2003 guidance presented recommendations in a paragraph format. The Guideline Committee highlighted some sections of the original guidance as still relevant to clinical practice, and other sections as out of date. Recommendations that are no longer relevant have been deleted. Recommendations that are still relevant to clinical practice have been transferred as individual recommendations labelled [2003], and the evidence for these has not been reviewed. Any amendments that change the meaning of recommendations labelled [2003, amended 2016] are explained in Amended recommendation wording (change to meaning). This is an exception to NICE's standard guideline development process and has been done so that relevant recommendations in the chapter not being updated could be carried across into this update.

Amended recommendation wording (change to meaning)

Recommendation in 2003 guideline

Recommendation in current guideline

Reason for change

Every patient with any form of haematological cancer (including myelodysplasias and chronic myeloproliferative disorders) should be managed by a haemato‑oncology MDT.

1.3.3 Every patient with any form of haematological cancer (as defined by current World Health Organization [WHO] criteria) should be cared for by a haemato‑oncology MDT.

This reference has been added to confirm how all haematological cancers are defined.

Each haemato-oncology MDT must include sufficient core members for the following people to be present at every meeting:

  • Haemato-oncologists (principally haematologists, some medical oncologists)

    • At least two who specialise in each tumour type being discussed at that meeting(e.g. leukaemia or lymphoma). At least one from each hospital site contributing to the MDT

  • Haemato-pathologist

    • At least one specialist in haematopathology who liaises with pathologists from other hospital sites;

  • Nurses

    • At least one clinical nurse specialist, also ward sisters from hospitals which provide services at BCSH Level 2 or above.

  • Palliative care specialist

    • At least one palliative care specialist(doctor or nurse) who liaises with specialists from other sites. If, because of staff shortages, a palliative care specialist cannot regularly attend MDT meetings, the MDT must be able to demonstrate that it reviews patients regularly with such a specialist

  • Support staff

    • Staff to organise team meetings and provide secretarial support.

1.3.9 Each haemato-oncology MDT should include sufficient core members for the following people to be present in person or remotely (for example via video conferencing) at every meeting:

  • Haemato-oncologists (either haematologists or some medical oncologists): at least two who specialise in each tumour type being discussed at that meeting (e.g. leukaemia or lymphoma). At least one from each hospital site contributing to the MDT.

  • Haematopathologist: at least one haematopathologist from the SIHMDS should be present; to provide the diagnostic information.

  • Nurses: at least one clinical nurse specialist, also ward sisters from hospitals which provide high-intensity chemotherapy.

  • Palliative care specialist: at least one palliative care specialist (doctor or nurse) who liaises with specialists from other sites. If, because of staff shortages, a palliative care specialist cannot regularly attend MDT meetings, the MDT should be able to demonstrate that it reviews patients regularly with such a specialist.

  • Support staff: staff to organise team meetings and provide secretarial support.

The opening paragraph has been amended to show that MDT members can be present at meetings remotely.

The first bullet point has been amended to avoid showing a preference for haematologists as this was unnecessary.

The second bullet has been amended to reference the SIHMDS recommended in this update.

The BCSH Levels of Care have been replaced, as they are no longer applicable.

Teams responsible for managing patients with myeloma should include at least one radiologist who liaises with radiologists at other sites and is fully and regularly involved in MDT discussions. It is not necessary for clinical oncologists to regularly attend team meetings for discussion of myeloma patients, although teams which manage these patients need rapid access to oncologists for palliative radiotherapy.

1.3.11 Teams responsible for managing patients with myeloma should include at least one radiologist who liaises with radiologists at other sites and is fully and regularly involved in MDT discussions. Teams that care for patients with myeloma should have rapid access to oncologists for palliative radiotherapy, although it is not necessary for clinical oncologists to regularly attend team meetings.

The second sentence of this recommendation has been amended to give it a clear action.

MDT meetings have the following functions:

  • To establish, record and review diagnoses for all patients with the forms of cancer that fit the team's definition criteria;

  • To assess the extent of each patient's disease and discuss its probable course;

  • To work out treatment plans for all new patients and those with newly-diagnosed relapses;

  • To review decisions about treatment, particularly those made in the interval between MDT meetings. This review should cover not only the clinical appropriateness of the treatment but also the way patients' views were elicited and incorporated in the decision-making process;

  • To discuss patients' responses to treatment, both during therapy and when the course of treatment is complete Lymphoma MDTs should review each patient's progress after three cycles of chemotherapy and again at the end of the prescribed course. The appropriateness of radiotherapy should be considered in the light of the response to chemotherapy;

  • To consider patients' other requirements such as palliative care or referral to other services. MDTs must be able demonstrate effective systems for collaboration with hospital and community palliative care services;

  • To discuss discontinuing treatment. Each MDT should develop a specific process for considering discontinuation of treatment when its effectiveness has become so limited that adverse effects might outweigh potential benefits;

  • To agree dates for reviewing patients' progress;

  • To discuss clinical trials and audit results.

1.3.17 At each meeting, the MDT should:

  • ensure that all new diagnoses have had SIHMDS review and integrated reporting

  • establish, record and review diagnoses for all patients with the forms of cancer that fit the team's definition criteria

  • assess the extent of each patient's disease and discuss its probable course

  • work out treatment plans for all new patients and those with newly-diagnosed relapses

  • review decisions about treatment, particularly those made in the interval between MDT meetings. This review should cover not only the clinical appropriateness of the treatment but also the way patients' views were elicited and incorporated in the decision-making process

  • discuss the response to treatment, both during therapy and when the course of treatment is complete

  • think about the appropriateness of radiotherapy in the light of the response to chemotherapy

  • think about the patients' other requirements such as palliative care or referral to other services. MDTs should be able to demonstrate effective systems for collaboration with hospital and community palliative care services

  • discuss discontinuing treatment. Each MDT should develop a specific process for considering discontinuation of treatment when its effectiveness has become so limited that adverse effects might outweigh potential benefits

  • agree dates for reviewing patients' progress

  • discuss clinical trials and audit results.

This recommendation has been changed to give it a clear action. In addition, a reference to SIHMDS review has been added to match the recommendation on diagnostic reporting in this update.

Reference to lymphoma MDTs has been removed because the recommendations will be superseded by the NICE guideline on non-Hodgkin's lymphoma (publication expected July 2016).

'consider' has been changed to 'think about' to avoid confusion with current NICE style for actions in recommendations.

'must' has been changed to 'should' to match current NICE style for actions in recommendations.

The MDT is also responsible for:

  • Identifying requirements for staff and facilities for any form of treatment it provides (see Topic 5, Treatment, excluding high dose therapy, and Topic 6, High dose therapy).

  • Liaison with primary care teams, palliative care teams, services for the elderly and voluntary organisations such as hospices;

  • Ensuring that adequate information, advice and support is provided for patients and their carers throughout the course of the illness;

  • Ensuring that GPs are given prompt and full information about the nature of their patients' illness or treatment, any changes in management, and the names of individual MDT members who are primarily responsible for their patients' management;

  • Recording, in conjunction with the cancer registry, the required minimum dataset for all cases of haematological cancer within its specified catchment area, including those cared for by clinicians who are not haematological cancer MDT members;

  • Identifying training needs of MDT members and making sure these needs are met;

  • Involvement in clinical trials and other research studies;

  • Collaboration in planning, and collecting data for, network-wide audit.

1.3.18 The MDT should:

  • review all SIHMDS reports of borderline conditions such as aplastic anaemia and other non‑malignant bone marrow failure syndromes (which overlap with hypoplastic myelodysplastic syndrome), and lymphocyte and plasma cell proliferation of uncertain significance (which overlap with lymphoma and myeloma)

  • identify requirements for staff and facilities for any form of treatment it provides

  • liaise with primary care teams, palliative care teams, services for the elderly and voluntary organisations such as hospices

  • ensure that adequate information, advice and support is provided for patients and their carers throughout the course of the illness

  • ensure that GPs are given prompt and full information about the nature of their patients' illness or treatment, any changes in management, and the names of individual MDT members who are primarily responsible for their patients' management

  • record, in conjunction with the cancer registry, the required minimum dataset for all cases of haematological cancer within its specified catchment area, including those cared for by clinicians who are not haemato‑oncology MDT members

  • identify the training needs of MDT members and make sure these needs are met;

  • be involved in clinical trials and other research studies

  • collaborate in planning, and collecting data for audit.

This has been updated to reflect the recommendations made in section 1.1.

The reference to Topics 5 and 6 has been removed because these chapters have been deleted.

A designated member of the team's support staff, working with the administrative head of the team, should be responsible for communication with primary care, palliative care, and other MDTs in the network

1.3.27 A designated member of the team's support staff, working with the administrative head of the team, should be responsible for communication with primary care, palliative care, and other site-specific MDTs.

The reference to networks has been amended, as these no longer exist.

Each haemato-oncology MDT which provides treatment at BCSH Level 2 or above must have facilities as specified by BCSH and must be able to demonstrate adequate arrangements for 24‑hour cover by specialist medical and nursing staff. These arrangements must be sufficiently robust to allow cover for holidays and other absences of team members.

1.3.31 Each haemato‑oncology MDT which provides high-intensity chemotherapy should have facilities as specified in section 1.2, and should be able to demonstrate adequate arrangements for 24‑hour cover by specialist medical and nursing staff. These arrangements should be sufficiently robust to allow cover for holidays and other absences of team members.

The BCSH Levels of Care have been replaced, as they are no longer applicable.

In addition, 'must' has been changed to 'should' to match current NICE style for actions in recommendations.

All hospitals which give chemotherapy, or which are likely to admit patients undergoing chemotherapy as medical emergencies, should have documented clinical policies, agreed with haematology and oncology staff, which clearly specify arrangements for the care of such patients.

1.3.32 All hospitals which give high-intensity (non-transplant) chemotherapy for induction or re-induction of remission, or consolidation, or which are likely to admit patients undergoing chemotherapy as medical emergencies, should have documented clinical policies, agreed with haematology and oncology staff, which clearly specify arrangements for the care of such patients.

The reference to chemotherapy has been amended to match the levels of care defined in this update.

ISBN: 978-1-4731-1867-6

  • National Institute for Health and Care Excellence (NICE)