Quality statement 2: Multidisciplinary review

Quality statement

Adults with oesophago-gastric cancer have their treatment reviewed by a multidisciplinary team (MDT) that includes an oncologist and a specialist radiologist who both have an interest in oesophago-gastric cancer.

Rationale

Adults with oesophago-gastric cancer have their care reviewed in an MDT meeting so that their treatment can be planned. Including a radiologist and an oncologist who both have a specialist interest in oesophago-gastric cancer means that the MDT has a range of specialist expertise. When these 2 roles and associated specialist expertise are included in local MDTs this can help reduce time to treatment and unnecessary referrals to specialist MDTs.

Quality measures

Structure

Evidence that an oncologist and a radiologist who both have a specialist interest in oesophago-gastric cancer take part in multidisciplinary team meetings.

Data source: Local data collection, for example, attendance records gathered to support the Quality Surveillance Programme, minutes of MDT meetings or MDT annual reports.

Process

Proportion of adults with newly diagnosed oesophago-gastric cancer whose treatment is reviewed at a multidisciplinary meeting that includes an oncologist and a radiologist who both have a specialist interest in oesophago-gastric cancer.

Numerator – the number in the denominator whose treatment is reviewed at a multidisciplinary meeting that includes an oncologist and a radiologist who both have a specialist interest in oesophago-gastric cancer.

Denominator – the number of adults with newly diagnosed oesophago-gastric cancer.

Data source: Local data collection, for example, attendance records gathered to support the Quality Surveillance Programme, minutes of MDT meetings or MDT annual reports.

Outcome

a) Rates of referral from a local MDT to a specialist oesophago-gastric cancer MDT.

Data source: Local data collection.

b) Average time from MDT to first treatment for oesophago-gastric cancer.

Data source: National Oesophago-Gastric Cancer Audit waiting times between key dates in the patient pathway by treatment modality in England and Wales (table 5.2).

What the quality statement means for different audiences

Service providers (secondary care services) ensure that arrangements are in place for MDTs planning and reviewing treatment for adults with oesophago-gastric cancer to have an oncologist and a radiologist who both have a specialist interest in oesophago-gastric cancer as core members of the team. When these core members are unable to attend meetings, they arrange cover from oncologists and radiologists with the same specialist interest.

Healthcare professionals (oncologists and radiologists with a specialist interest in oesophago-gastric cancer) take part in MDT reviews of treatment for adults with oesophago-gastric cancer and are core members of the team.

Commissioners (clinical commissioning groups and NHS England) have clinical protocols and network policies in place to ensure that MDTs responsible for planning and reviewing treatment for adults with oesophago-gastric cancer include as core members an oncologist and radiologist who both have a specialist interest in oesophago-gastric cancer. Their attendance at MDT reviews is monitored.

Adults with oesophago-gastric cancer are cared for by a team of healthcare professionals who have training and experience in caring for people with oesophago-gastric cancer. The team is responsible for planning care.

Source guidance

Oesophago-gastric cancer: assessment and management in adults (2018) NICE guideline NG83, recommendation 1.2.1

Definitions of terms used in this quality statement

Multidisciplinary team

The focus of the statement is on the roles of the oncologist and specialist radiologist. The core roles of the full MDT would include:

  • clinical nurse specialist

  • specialist clinical oncologist with an interest in oesophago-gastric cancer

  • gastroenterologist

  • specialist medical oncologist (if the responsibility for chemotherapy is not undertaken by the clinical oncologist) with an interest in oesophago-gastric cancer

  • palliative care specialist

  • specialist radiologist with an interest in oesophago-gastric cancer

  • upper gastrointestinal surgeon.

Other roles will form part of an extended local or specialist MDT.

[Adapted from NHS Executive (2001) Guidance on commissioning cancer services: improving outcomes guidance in upper gastro-intestinal cancers: the manual. London, Department of Health: topic area 3; expert opinion]