Demand for cancer care is growing. Meanwhile, a widening range of treatment options and an ageing population with more comorbidities mean that clinical decision-making is becoming increasingly complex. Amid these challenges, the NHS Cancer Plan for England presents an opportunity to radically overhaul cancer decision-making processes to allow teams to deliver better care.

In this opinion piece, Nicky Thorp (Vice-President for Clinical Oncology at the Royal College of Radiologists, UK) provides a 6-point reform plan to improve the ways MDT meeting’s are run for patients and clinicians. 

Collaboration is key in cancer decision-making

Many cancer clinicians recognize that the collaborative approach of the multidisciplinary team (MDT) is essential. At their best, MDTs ensure high-quality patient care and collect and use data to continually improve the service and reduce variation.

MDT meetings do not meet the demands of modern healthcare

However, many clinicians also agree that the main forum for MDT working – the weekly MDT meeting – takes too much of their time to prepare for and attend, and too often does not live up to its purpose of improving patient outcomes.

In cancer centers across the country, MDT meetings are routinely used to discuss the care of every single new patient with cancer. It has become established practice that no decisions about the management of a patient’s cancer can be made without first being discussed at an MDT meeting. While discussing all decisions as a team may seem well-intentioned, it can have negative consequences. Waiting for the weekly meeting needlessly delays treatment decisions for those patients who have a plan that would not benefit from discussion with the whole team. In this way, the current system is adding delays to time-critical cancer pathways that are already stretched by staff shortages and backlogs.

As cancer incidence has increased, more patients are being discussed at MDT meetings. But despite meetings often lasting for hours, the time spent discussing each patient has become shorter. One study found that only half of cases are discussed for more than 2 minutes, and discussions towards the end tend to be shorter and of lower quality.

A clinical consensus for a radical rethink

There is strong evidence and a growing consensus in favor of reforming MDT meetings. Several Getting it Right First Time (GIRFT) reports and national cancer (NATCAN) audits have found persistent, significant variation in UK cancer care and patient outcomes, despite the time clinicians spend on MDT meetings.

Indeed, NHS England recognized that MDT meetings should be streamlined in a 2020 report – but change still has not happened.

Royal Colleges and expert bodies representing clinicians who work in cancer MDTs agree that next year’s NHS Cancer Plan for England must seize the opportunity to make MDT meetings fit for purpose and that the other UK nations should follow a similar example.

Six ways cancer MDT meetings need to change

The Royal College of Radiologists (RCR), Royal College of Physicians (RCP), Royal College of Nursing (RCN), Royal College of Pathologists (RCPath), and Association of Cancer Physicians (ACP) agree that MDT meetings in their current form are inefficient. They agree that the NHS Cancer Plan for England should commit to six key changes:

MDT meetings should only be used to discuss the most complex cases. Reserving discussion for cases that will genuinely benefit from an in-depth review by clinicians from multiple disciplines would facilitate better decision-making for these patients with complex cases, and faster treatment decisions for other patients outside of the MDT meeting. It would be a more efficient and effective use of clinicians’ time.
MDT meetings should be repurposed for activities like quality improvement and training. Teams should meet regularly to review and improve processes using patient outcome data and the latest audit and research findings. This would help improve service quality and integrate new team members.
MDT meetings should be attended only by those who are required and who can actively contribute. This would improve efficiency and give clinicians time back that would be better spent caring for patients. External experts are sometimes needed in areas such as genomics. Where these experts are not based locally, they must be facilitated to join meetings, where necessary, through modern IT.
MDT meetings should not be used as the sole decision-making forum for cancer treatment. Instead of waiting for the weekly MDT meeting, teams should be equipped with nationally agreed pathways and protocols to make faster, more consistent and more equitable treatment decisions outside the meeting. This could reduce delays and improve patient outcomes.
MDT meetings must be truly focused on patient-centered care. For instance, reducing the number of inappropriate tests for some frail patients with multiple comorbidities.
MDT meetings should be used to collect and analyze high-quality, consistent data to inform service development. Currently, data collected on diagnoses and treatments are inconsistent and often inaccurate. Better data collection would help teams to identify weaknesses and make improvements.

Clinicians need agreed guidance to make consistent, high-quality treatment decisions

A lack of agreed guidance is causing variation in cancer care around the country. For changes to MDT meetings to be safe and effective, clinicians must be supported with nationally agreed guidance, optimal treatment pathways and protocols that help them to make treatment decisions outside of MDT meetings.

All cancer centers must currently write and maintain their own pathways and protocols for radiotherapy and systemic anti-cancer therapies (SACT) due to the lack of agreed guidance. This unnecessary duplication of SACT protocols costs anywhere from £1 million up to nearly £2 million per year in staff time. Creating it once, nationally, would save time and money and reduce variation in the care patients receive.

The Royal College of Radiologists has offered to lead this work. As we wait for the Cancer Plan to be published, we continue to make the case for reforming MDT meetings so that patients and clinicians can benefit.

Author profile: 

Dr Nicky Thorp is Vice-President for Clinical Oncology at the Royal College of Radiologists. Nicky trained in medicine at the University of Leicester (UK), graduating in 1990. She completed her specialist oncology training at the Clatterbridge Cancer Centre (UK). She was appointed as a consultant clinical oncologist in 2001 at Clatterbridge with subspecialty interests in breast cancer, pediatric radiotherapy and late effects. In 2019 she took up her post at the Christie Hospital in Manchester (UK) specializing in photon and proton beam therapy for children. Her research interests are in aediatric tumors and radiotherapy quality assurance. She was previously radiotherapy lead for the NCRI CCL CNS Subgroup and is UK radiotherapy lead for the pan-European SIOP Ependymoma II study.

Nicky was Medical Director for Professional Practice for Clinical Oncology at the Royal College of Radiologists from September 2021 to August 2024 and is currently Co-lead for Wellbeing at the RCR. She previously served two terms on the RCR CO Faculty Board.

Nicky was Associate Medical Director at Clatterbridge between 2010 and 2016. Her roles included clinical lead for the new build Clatterbridge Cancer Centre-Liverpool. She served two terms on the Children’s Cancer and Leukaemia Group (CCLG) Executive and is past chair of the CCLG Radiotherapy and Neuro-oncology Groups.

The opinions expressed in this interview are those of the author and do not necessarily reflect the views of Oncology Central or Taylor & Francis Group.

No potential competing interest were reported by the contributors to this feature.