Multidisciplinary Care Teams and Patient Centricity in Small Cell Lung Cancer

Blanca Ledezma


Blanca Ledezma, Nurse Practitioner, Ronald Reagan UCLA Medical Center

As our knowledge and understanding of lung cancer has increased, so too has the complexity of treatment and the importance of having a team of multidisciplinary experts involved in care. For many newly diagnosed lung cancer patients, navigating multiple experts and care providers can at first be more than a little bit daunting. But, in fact, as many patients soon come to realize, effective multidisciplinary care teams (MDTs) may help ensure a better patient experience and maybe even better lung cancer outcomes.

For lung cancer patients, the MDT (sometimes convened through a tumor board) typically involves a variety of physician specialists, including a medical oncologist, radiation oncologist, thoracic surgeon and pulmonologist – as well as nurses, nurse practitioners, pharmacists, social workers, dietitians and others involved in the various aspects and stages of patient care. Unlike the more traditional serialized approach to care – in which the patient and responsibility for their care are handed over from one physician to the next as patients move through diagnoses and treatment – MDTs meet at regular intervals to discuss patient cases within the context of their specialties and decide together on the best course of treatment. This coordinated and holistic approach helps offer a continuity of care that may ultimately lead to improved outcomes for patients.

In my experience, MDTs can be especially important for patients with complex or aggressive diseases-such as small cell lung cancer (SCLC)-which can present both patients and their care teams with a number of unique challenges. For example, approximately two-thirds of patients with small cell lung cancer are diagnosed with extensive-stage disease (ES-SCLC), when the cancer has already metastasized to both lungs or other more distant parts of the body. Notably, SCLC has a higher propensity to metastasize to the brain than many other solid tumors, with approximately 10% - 20% of patients presenting with brain metastases and 40% - 60% likely to develop them during the course of their disease. SCLC is also often diagnosed in the presence of other chronic medical conditions. Concerns and risks around decreased life expectancy, physical activity limitations, interactions between the chronic condition and the cancer therapy or adverse reactions due to concomitant medications can impact and complicate therapeutic options. Given the above, it is unsurprising then that patients with SCLC tend to present as more symptomatic, frailer and often with a higher burden of comorbidities – making immediate intervention not only imperative but all the more complex. The MDT naturally convenes the various specialists and experts necessary to manage this type of multifaceted care.

As valuable as an MDT can be to lung cancer care, the approach is not without its challenges. Effective leadership, strong teamwork and sufficient administrative support are all important factors that can help ensure both the efficacy and efficiency, and ultimately the overall value, of the MDT. However, at a fundamental level, it’s ensuring effective communication that is perhaps most critical to the overall success of the MDT. In my experience, breakdowns in communication can cause care to feel disjointed and disconnected for patients, potentially leading to delays or disruptions in care that could be detrimental for patients with an aggressive disease such as SCLC. All members of the MDT must be aware of the status and trajectory of treatment so that they can work with each other and with the patient to provide optimal, cohesive care.

Ensuring effective communication typically requires investment in support staff and specialized tools or systems that allow for the coordination, centralization and easy sharing of information. In my work, one of the approaches our team utilizes is an online portal which allows the MDT to communicate more effectively with each other and helps me to better coordinate each patient’s appointments and care regimen. Obviously, resources vary across practices and systems, but investing in the appropriate tools, systems or support are important to the effectiveness of the MDT and avoiding placing an undue burden on care teams.

In my work as an oncology Nurse Practitioner, I work closely with patients throughout their treatment journey – from helping them understand their diagnosis and coordinating treatment visits, to managing their treatment and symptoms. I see firsthand the impact that effective MDTs can have on cancer care – not simply improved outcomes but a stronger focus on the holistic well-being of patients. And for patients with ES-SCLC, who face a difficult and aggressive disease with a poor prognosis, these improvements can mean the world. And when this multidisciplinary approach is paired with management, which may involve guideline recommended treatments, patients are more likely to have improved outcomes.