3.2 Treatment planning

3.2 Treatment planning

The responsibilities of the multidisciplinary team are to:

  • nominate a team member to coordinate patient care and identify this person to the patient
  • nominate a team member to be the lead clinician (the lead clinician may change over time depending on the stage of the care pathway and where care is being provided) and identify this person to the patient (if different from the care coordinator)
  • develop and document an agreed treatment plan at the multidisciplinary team meeting (including consideration of clinical trial options)
  • communicate/circulate the agreed multidisciplinary team treatment plan to relevant team members, including the patient’s general practitioner
  • inform quality and safety improvements, collect data and benchmark outcomes.

The general or primary medical practitioner who made the referral is responsible for the patient until care is passed to another practitioner.

The general or primary medical practitioner may play a number of roles in all stages of the cancer pathway including diagnosis, referral, treatment and coordination and continuity of care as well as providing information and support to the patient and their family.

The care coordinator is responsible for ensuring there is continuity throughout the care process and coordination of all necessary care for a particular phase. The care coordinator may change over the course of the pathway.

The lead clinician is responsible for overseeing the activity of the team.

The multidisciplinary team should comprise the core disciplines that are integral to providing good care. Team membership will vary according to cancer type but should reflect both clinical and psychosocial aspects of care. Additional expertise or specialist services may be required for some patients (Department of Health 2007b).

Team members may include:

  • a cancer nurse (with appropriate expertise)*
  • a care coordinator (as determined by multidisciplinary team members)*
  • a dietitian*
  • a medical oncologist*
  • a musculoskeletal radiologist*
  • a paediatric surgeon*
  • a pathologist*
  • a radiation oncologist*
  • a reconstructive surgeon*
  • a social worker*
  • a surgical oncologist*
  • an expert in providing culturally appropriate care to Aboriginal and Torres Strait Islander patients (this may be an Aboriginal and Torres Strait Islander health worker, health practitioner or hospitality liaison officer)*
  • an expert in the psychosocial care of AYA (with preference for a representative from a youth cancer service)*
  • an orthopaedic oncologist*
  • an orthotist/prosthetist*
  • a clinical trials coordinator
  • a fertility specialist
  • a general practitioner
  • a nuclear medicine specialist
  • a palliative care specialist
  • a pharmacist
  • a physiotherapist and/or exercise physiologist
  • a psychiatrist
  • a psychologist
  • a rehabilitation physician
  • a speech therapist
  • a thoracic surgeon.
  • an occupational therapist

* Core members of the multidisciplinary team are expected to attend most multidisciplinary team meetings either in person or remotely.

All newly diagnosed patients should be discussed in a multidisciplinary team meeting before beginning treatment. The level of discussion may vary depending on clinical and psychosocial factors. Teams may agree standard treatment protocols for non-complex care facilitating patient ascertainment and associated data capture.

A treatment plan for each case should be discussed at the beginning of treatment to determine timing and the choice of surgical resection, surgical reconstruction and radiation therapy to minimise surgical-related and radiation therapy-related morbidity (Cancer Council Australia Sarcoma Guidelines Working Party 2014).

The results of all relevant tests and imaging should be available for the multidisciplinary team discussion. The care coordinator or treating clinician should also present information about the patient’s concerns, preferences and social circumstances (Department of Health 2007c).