A multidisciplinary approach to managing patients

A multidisciplinary approach to managing patients

For more than 20 years, journal articles published by leaders in the field have advocated a multidisciplinary approach when assessing management options for patients with neuroendocrine tumors.1-8

The literature suggests that a well-represented multidisciplinary team include specialists such as gastroenterologists, surgeons, oncologists, endocrinologists, interventional radiologists, pathologists, nuclear medicine experts, nurses, and social workers/case managers.2,9

"Because there are so many therapeutic options available for patients with NETs... and each specialist brings a different perspective... it's important that we optimize care for these patients. It's important to integrate that care and use it in a timely fashion."—Dr Larry Kvols

Potential advantages of using a multidisciplinary team approach to tumor management may include3

  • Accurate diagnosis and staging
  • Evaluation of performance status and quality of life
  • Consensus regarding the patient's care plan
  • Cohesive delivery of support, therapy, and information on prognosis to patients
  • Continuous reassessment, discussion, and peer review of the individualized care plan

Expert Collaboration

A look at how NET specialists from different areas of expertise can work together to make informed management decisions for patients.

Many multidisciplinary teams that currently manage NET patients work out of specialist centers, managing patients on-site or offering guidance for management at the community level.

"I think the appreciation of all the many tests that need to be done, all the many treatments that are out there... and then the order of those treatments is challenging. It really involves more than one decision by one specialty. It really involves an integration."—Dr Lowell Anthony

Each center is modeled differently. Not all specialists are present in all centers. Ideally, in light of the variable nature of many of these neoplasms, routes of communication to all specialists involved should be clear and well defined. Existing literature also notes that data collection should be prospective, so that cases can be audited and outcomes compared between centers.3

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Managing from a nurse's perspective

nurse's perspective

Tips to educate, engage, and empower your patients.

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NET Fact

Multidisciplinary Approach

50% of all patients have either regional or distant metastases at diagnosis.

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Yao JC et al. J Clin Oncol. 2008;26(18):3063-3072.

 

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1. Moertel CG. Treatment of the carcinoid tumor and the malignant carcinoid syndrome. J Clin Oncol. 1983;1(11):727-740.
2. Caplin ME, Buscombe JR, Hilson AJ, Jones AL, Watkinson AF, Burroughs AK. Carcinoid tumour. Lancet. 1998;352(9130):799-805.
3. Banfield A, Green S, Ramage JK. Neuroendocrine tumor management: a team approach. Hosp Med. 2005;66(1):37-42.
4. Zuetenhorst JM, Taal BG. Metastatic carcinoid tumors: a medical review. Oncologist. 2005;10(2):123-131.
5. Ramage JK, Davies AHG, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005;54(suppl 4):iv1-iv16.
6. Boudreaux JP, Putty B, Frey DJ, et al. Surgical treatment of advanced-stage carcinoid tumors. Ann Surg. 2005;241(6):839-846.
7. Chambers AJ, Pasieka JL, Dixon E, Rorstad O. The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors. Surgery. 2008;144(4):645-653.
8. Steinmüller T, Kianmanesh R, Falconi M, et al. Consensus guidelines for the management of patients with liver metastases from digestive (neuro)endocrine tumors: foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2008;87(1):47-62.
9. McStay MKG, Caplin ME. Carcinoid tumour. Minerva Med. 2002;93(5):389-401.
1. Moertel CG. Treatment of the carcinoid tumor and the malignant carcinoid syndrome. J Clin Oncol. 1983;1(11):727-740.
2. Caplin ME, Buscombe JR, Hilson AJ, Jones AL, Watkinson AF, Burroughs AK. Carcinoid tumour. Lancet. 1998;352(9130):799-805.
3. Banfield A, Green S, Ramage JK. Neuroendocrine tumor management: a team approach. Hosp Med. 2005;66(1):37-42.
4. Zuetenhorst JM, Taal BG. Metastatic carcinoid tumors: a medical review. Oncologist. 2005;10(2):123-131.
5. Ramage JK, Davies AHG, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005;54(suppl 4):iv1-iv16.
6. Boudreaux JP, Putty B, Frey DJ, et al. Surgical treatment of advanced-stage carcinoid tumors. Ann Surg. 2005;241(6):839-846.
7. Chambers AJ, Pasieka JL, Dixon E, Rorstad O. The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors. Surgery. 2008;144(4):645-653.
8. Steinmüller T, Kianmanesh R, Falconi M, et al. Consensus guidelines for the management of patients with liver metastases from digestive (neuro)endocrine tumors: foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2008;87(1):47-62.