The treatment of breast cancer is complex and should involve specialists from many different fields.
For the person with breast cancer it can feel like there is an endless string of doctors and health practitioners, each saying something different. The result is that a person with breast cancer can feel afraid and unsure about what exactly is happening with their body. The person who they know and trust the most – their family doctor – may not be part of the process which can add to the patient’s feelings of insecurity.
We are lobbying for a system of multidisciplinary care in South Africa which will bring all the different specialist care providers together and provide clear information to the person with breast cancer.
Multidisciplinary care is another way of saying: TEAM WORK!
The ‘gold standard’ for multidisciplinary care is a team that meets regularly and plans the treatment options and care for all patients within a tumour group. The care of each individual patient should be discussed by the team, and the family doctor needs to be part of the discussion wherever possible. The team also needs to include allied health and psychosocial health practitioners.
We do, however, need to be realistic. The ‘gold standard’ is something worth aiming for, but right now in South Africa just having different professionals talking to each other about their patients would be progress.
All core disciplines should have regular meetings to provide input to diagnostic, treatment, support and palliative care planning. There needs to be a clear communications path set up so that discussions and decisions can be shared with practitioners who are unable to attend a particular meeting.
Within this system, decisions, protocols and care pathways will be in line with the current best practice, and will include the latest research. In this way, multidisciplinary team meetings can also be seen as part of the ongoing professional development of each practitioner.
Collaborative links will be formed with the smaller referring centres. This creates a strong network of multidisciplinary teams and practitioners across and between integrated breast cancer services.
What do we expect the result of this system to be?
In an ideal world, the most important result will be that all people with breast cancer will have information about and access to relevant treatment and services. The way that the multidisciplinary team works and makes recommendations needs to be explained to the patent. There must be clear communication so that each person with breast cancer can feel connected to the planning of their own treatment.
In reality, we face the question of: WHO WILL PAY FOR THIS SERVICE? It will require creative thinking to get this funded. It may even require a rethink of how our funding model works in order to accommodate whole patient care.
In the meantime, we need to make sure that the teams that do exist in our State and Private hospitals are fully functioning as teams. This way of working must be taught in medical schools.
Newly diagnosed people with breast cancer need to know that they can be assertive and demanding about their treatment. When possible, they need to choose their team and insist that the surgeon and oncologist speak to each other and to the general practitioner. They also need to insist on seeing an oncologist before surgery as this may influence treatment decisions.