3.4.2 Timing for multidisciplinary team planning

Induction treatment is often required before a full MDM ratifies details of the ongoing management plan (which should include full details of the response assessment). Most patients will receive their initial treatment as inpatients, allowing their initial multidisciplinary treatment planning to be established on the ward. For patients undergoing induction chemotherapy, presentation to, and consideration within, an MDM is most important once the outcome of the induction therapy is known. At this point, a review of the patient is required to inform further management and supportive care needs.

For patients not eligible for induction chemotherapy, or where uncertainty of the approach exists, a review at an MDM should occur as soon as practicable (before definitive treatment), to establish the recommended treatment plan and all aspects of supportive care, including early preparation for the post-treatment phase.

The level of discussion may vary, depending on the patient’s clinical and supportive care factors. Some patients with non-complex cancers may not be discussed by a multidisciplinary team; instead the team may have treatment plan protocols that will be applied if the patient’s case (cancer) meets the criteria. If patients are not discussed at an MDM, they should at least be named on the agenda for noting. The proposed treatment must be recorded in the patient’s medical record and should be recorded in an MDM database where one exists.

Teams may agree on standard treatment protocols for non-complex care, facilitating patient review (by exception) and associated data capture.

Results of all relevant tests and access to images should be available for the MDM. Information about the patient’s concerns, preferences and social and cultural circumstances should also be available.