Pchela І. MULTIDISCIPLINARY COOPERATION IN TREATMENT AND REHABILITATION OF CANCER PATIENTS

Abstract: The article examines the use of multidisciplinary team (MDT) care to increase survival rate and improve perceived quality of care in cancer patients with all stages of malignant disease. The analysis of four peer-reviewed articles published since 2015 was carried out to identify benefits and limitations of interdisciplinary cooperation in treatment and rehabilitation of cancer patients. The article also examines barriers to the use of MDT care to treat and rehabilitate cancer patients in Ukrainian and foreign contexts. Recommendations for further research are provided.
Keywords: Cancer, malignant disease, multidisciplinary team (MDT), multidisciplinary care, interdisciplinary collaboration, survival rate, perceived quality of care, quality of life, change management frameworks.

The growing cancer survival rates encourage experts reexamining their approaches to designing rehabilitation programs for cancer patients. Three peer-reviewed articles published since 2015 have been examined to analyse and evaluate advantages and limitations of multidisciplinary care teams (MDT) for treatment and rehabilitation of cancer patients. The purpose of the article is to draw conclusions about the appropriateness of multidisciplinary cooperation in treatment and rehabilitation of cancer patients.
Although interdisciplinary teams are a novel phenomenon in Ukrainian healthcare settings, interdisciplinary cooperation is gaining momentum in western countries that report constantly increasing survival rates and life expectancy after cancer treatment interventions. C. Saint-Pierre et al [1] in their article Multidisciplinary Collaboration in Primary Care: A Systematic Review define MDT as “a group of professionals from two or more disciplines who work on the same project, independently or in parallel.” According to experts [1], multidisciplinary cooperation is commonly rooted in four types of collaboration, namely, co-located collaboration, non-hierarchal collaboration, collaboration through shared consultation, and collaboration via referral/counter-referral. In times of the coronavirus crisis, members of MDTs use online platforms, teleconferencing, and other means of communication that are safe and encapsulate a plethora of opportunities to share information and insights.
Research shows that multidisciplinary cooperation is associated with an increased survival rateamong patients with different stages of cancer. Pan et al [2] analysed a cohort of 32,569 lung cancer patients whose treatment involved or did not involve multidisciplinary team care. The propensity score was applied as a control variable to reduce selection bias. The obtained findings suggested that in contrast to their counterparts whose treatment did not involve MDT care, patients with III and IV stages of non-small cell lung cancer,who received such ca are, had higher survival rate. Therefore, there is a reason to assert that the use of MDT care is correlated with higher survival rates in patients with any stage of cancer.
The use of MDTs is also associated with a profound positive effect on patient-reported experience of cancer care. Tremblay et al [3] surveyed a cohort of 1379 participants, who were recruited in nine outpatient oncology clinics of Quebec, Canada, to assess the impact of interdisciplinary cooperation on patient-reported experience of care across the following dimensions: Prompt access to care, Person-centered response, Quality of patient-professional communication, Quality of the care environment, Continuity of care, and Results of care. According to Tremblay et al [3], interdisciplinary cooperation was associated with positive patient-reported experience across all the mentioned dimensions of care. In some cases, for instance Prompt access to care, participants who were assigned to MDTs reported almost four times more positive perceptions of care. The correlation between the use of MDTs and patient experience of cancer care is particularly improtant in countries with health insurance, where customers are free to choose between a range of facilities competing for their out-of-pocket expenses. However, Ukrainian healthcare system is also recommended to take into account the correlation so as to obtain an in-depth understanding why cancer patients have low trust in existing protocols and postpone treatment whenever possible.
In spite of evident advantages, interdisciplinary cooperation also involves a number of challenges that should be taken into consideration when planning treatment and rehabilitation of cancer patients. The process of creating and maintaining MDTs is lengthy and resource-intensive. The problem becomes particularly prominent in times of the pandemic, when resources are mainly allocated to stop the spread of the disease.
Low commitment of oncologists to refer cancer patients to interdisciplinary treatment can also be a barrier to using multidisciplinary teams for treatment and rehabilitation of cancer patients. Of 845 cases of admission of cancer patients in MDT treatment settings, 94.1% cases included patients in the advanced stage of malignant disease [4]. On one hand, the statistic means that oncologists fail to acknowledge the importance of interdisciplinary cooperation for increasing survival rates and improving perceived quality of care in cancer patients. On the other hand, a considerable number of cancer patients with various stages of malignant disease are deprived of an opportunity to get holistic treatment and enjoy high quality of life.
Obviously, the main problem facing healthcare community both in Ukraine and abroad is to develop effective responses to the barriers hindering the use of MDTs in treatment and rehabilitation of cancer patients. Further research is needed to understand why the barriers emerge and persist. Also, analysis should be carried out to understand whether transformational frameworks, such as Kurt Lewin’s change model and Kottler’s change theory, can be helpful to overcome the barriers on the way to using multidisciplinary teams in treatment and rehabilitation of cancer patients. Lastly, analysis and evaluation of foreign experience may provide insights into the transferability of lessons learned about interdisciplinary cooperation into the Ukrainian health care context.

References
1. Saint-Pierre, C., Herskovic, V., Sepulveda, M. Multidisciplinary collaboration in primary care: A systematic review. Family practice. 2018.vol. 35, pp. 132-141.
2. Pan, C.C., Kung, P.T., Wang, Y.H., Chang, Y.C., Wang, S.T., Tsai, W.C. Effects of multidisciplinary team care on the survival of patients with different stages of non-small cell lung cancer: A national cohort study. PLoS One. 2015. Vol. 10. doi: 10.1371/journal.pone.0126547
3. Tremblay, D., Roberge, D., Touati, N., Maunsell, E., Berbiche, D. Effects of interdisciplinary teamwork on patient-reported experience of cancer care. BMC health services research. 2017.vol. 17. https://doi.org/10.1186/s12913-017-2166-7
4. Ballyuzek, M.F., Ionova, A.K., Mashkova, M.V., Stepanov, B.P., Chagunava, O.L. Organization of rehabilitation programs for cancer patients based on an interdisciplinary approach. Research and practical medicine journal. 2018. Vol. 5. https://doi.org/10.17709/2409-2231-2018-5-4-9