3.3 Treatment planning
Patients in the specific-CUP subset should be discussed at the MDT meetings of the tumour stream most closely related to the person’s CUP.
Patients who appear to fall into a non-specific CUP subset should be referred to a CUP-specific oncology service or else to the general medical oncology service, which can then triage them into the most appropriate clinic for ongoing care depending on the jurisdiction. Since most centres do not have a specific CUP clinic this may include the patient being seen in a general oncology clinic or a disease-specific clinic depending on the presentation and suspected diagnosis.
The complex nature of CUP, along with the advantages gained from multidisciplinary collaboration in this situation, argue strongly for establishing dedicated MDT services for this group, even if convened via tele- or video-conferencing. However, where CUP MDTs do not exist, an MDT with members who have expertise in managing CUP should discuss the patient.
The responsibilities of the MDT 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 MDT meeting
- communicate/circulate the agreed MDT treatment plan to relevant team members, including the patient’s GP.
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 for coordinating 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 MDT 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 2007a).
Team members may include a:
- care coordinator (as determined by MDT members)*
- medical oncologist*
- pathologist*
- radiologist*
- surgeon*
- nurse (with appropriate expertise)*
- radiation oncologist*
- social worker*
- clinical trials coordinator
- dietitian
- GP
- psychologist
- nuclear medicine physician
- occupational therapist
- specialist palliative care team member(s)
- pharmacist
- physiotherapist
- psychiatrist
- rehabilitation physician
- speech therapist.
* Core members of the MDT are expected to attend most MDT meetings either in person or remotely.
Treatment options for all newly diagnosed patients should be discussed in an MDT meeting before beginning treatment. The level of discussion may vary depending on both the clinical and psychosocial factors.
There may also need to be a review of existing treatment plans for patients who have been discussed previously.
Results of all relevant tests and imaging should be available for the MDT discussion. The care coordinator or treating clinician should also present information about the patient’s concerns, preferences and social circumstances at the meeting (Department of Health 2007a).
