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Impact of Multidisciplinary Team Meetings and Decision-Making on Cancer Management in Lower and Middle Income Countries

      To the Editor:
      Our team wishes to forward our comment on a study previously published in CHEST (December 2020).
      • Hoeijmakers F.
      • Heineman D.J.
      • Daniels J.M.
      • et al.
      Variation between multidisciplinary tumor boards in clinical staging and treatment recommendations for patients with locally advanced non-small cell lung cancer.
      We do commend the original academic work conducted by the authors of this study. With all due respect, our team wishes to register our difference of opinion that is based mainly on the fundamental message that is being conveyed unintentionally to the specialists serving in the developing world. In our humble opinion, it is imperative to comment on the inferences drawn from this study. The scientific findings depicted in this study are all factually correct, and we would like to praise all the authors on this authentic professional work. For specialists, like us, who are serving in the developing countries, site-specific multidisciplinary team (MDT) tumor boards are a life-line for our cancer patients’ quality health care.
      • Abbasi A.N.
      • Karim M.U.
      • Ali N.
      • Hafiz A.
      • Qureshi B.M.
      Multidisciplinary team tumour boards are a lifeline for our cancer patients in lower and middle income countries.
      It may not appear too important for the authors who are working in a system where 100% of cases are discussed in MDT. Here, in the developing world, we are struggling hard to develop these site-specific MDT tumor boards. Because of this reason, we need to get a very clear and loud message from the authors that stage IIIA non-small cell lung cancer comprises of heterogeneous mixture of cases and that variations in MDT opinions are quite natural and likely. The occurrence of differences of opinion is not a bad phenomenon because we do encourage a healthy debate and because we welcome arguments from all disciplines involved in the shared care.
      • Abbasi A.N.
      Establishment and maintenance of quality of site-specific multidisciplinary tumor boards in Pakistan.
      It is not possible to get a consensus recommendation in all stage IIIA non-small cell lung cancer cases discussed in an MDT tumor board because the decision that is taken by an MDT could be based on multiple medical and nonmedical factors of a patient.

      Holmes A, Kelly BD, Perera M, Eapen RS, Bolton DM, Lawrentschuk N. A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer [published online ahead of print June 4, 2020]. World J Urol. https://doi.org/10.1007/s00345-020-03265-1.

      In our opinion, there is a potential danger that someone can draw a negative inference from this published study. This may lead to stoppage of cases that are brought by physicians for discussion in tumor boards that are being conducted on a volunteer basis in developing countries where all cases are still not discussed in an MDT before the commencement of an oncologic treatment.

      Holmes A, Kelly BD, Perera M, Eapen RS, Bolton DM, Lawrentschuk N. A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer [published online ahead of print June 4, 2020]. World J Urol. https://doi.org/10.1007/s00345-020-03265-1.

      Unintentionally, a misleading message can be conveyed to some practicing clinicians who may consider MDT tumor boards as an optional activity, which is still not considered mandatory, for quality decision-making in the care of a patient in the environment in which they work.
      • Munro A.J.
      Multidisciplinary team meetings in cancer care: an idea whose time has gone?.

      References

        • Hoeijmakers F.
        • Heineman D.J.
        • Daniels J.M.
        • et al.
        Variation between multidisciplinary tumor boards in clinical staging and treatment recommendations for patients with locally advanced non-small cell lung cancer.
        Chest. 2020; 158: 2675-2687
        • Abbasi A.N.
        • Karim M.U.
        • Ali N.
        • Hafiz A.
        • Qureshi B.M.
        Multidisciplinary team tumour boards are a lifeline for our cancer patients in lower and middle income countries.
        Clin Oncol. 2016; 28: 799
        • Abbasi A.N.
        Establishment and maintenance of quality of site-specific multidisciplinary tumor boards in Pakistan.
        J Coll Physicians Surg Pak. 2016; 26: 805-807
      1. Holmes A, Kelly BD, Perera M, Eapen RS, Bolton DM, Lawrentschuk N. A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer [published online ahead of print June 4, 2020]. World J Urol. https://doi.org/10.1007/s00345-020-03265-1.

        • Munro A.J.
        Multidisciplinary team meetings in cancer care: an idea whose time has gone?.
        Clin Oncol. 2015; 27: 728-731

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