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Improving cancer care: treatment management

Christina Kling-Hassler MD
13 May, 2016  

Increased focus and investment in cancer care has brought to the forefront the necessity of multidisciplinary teams and a reform in the processes involved in delivering safe patient-centred care

Christina Kling-Hassler MD
Senior Advisor and Programme Manager at Regionalt Cancercentrum Stockholm-Gotland, Stockholm, Sweden 
Email: christina.kling-hassler@sll.se
 
Over the past few decades there has been a dramatic increase in the number of recorded cancer cases in the Nordic region, with over 100,000 new cases being reported each year.1 While this is largely due to the Nordic region’s ageing population, it is also because of the advancements made in cancer screening technology and practices, allowing for a much earlier diagnosis than ever before. 
 
While breast cancer is still the most prominent cancer among Swedish women  and prostate cancer among Swedish men, according to the Swedish Cancer Registry2 – there has been an increase in the prevalence of malignant melanoma and other skin cancer in the country, making it the second most common cancer in both men and women, followed by colon cancer. 
 
In step with other Nordic countries like Denmark and Norway, the Swedish government has adopted a national cancer strategy to respond to the growing number of cancer patients and the associated morbidity and mortality rates. This strategy involves further engagement with healthcare specialists from multidisciplinary backgrounds, decreasing long patient waiting times and implementing a more patient-centric approach through improved cancer patient management. 
 
While the above highlighted issues are common throughout the healthcare industry, in cancer care it is crucial to address them because of the prolonged care pathway that the patients have to go through. In Sweden, as in other Nordic countries, a cancer patient can expect to live for decades possibly3 with and after the cancer diagnosis if there is an optimal level of interaction and information sharing between the patient and involved healthcare providers and specialists. 
 
Norway was the first country globally to implement a national cancer plan in 1998, which was later superseded by a second strategy in 2006. These national cancer plans described objectives for prevention, screening, diagnostic activity, treatment, rehabilitation, cancer research and competence development. The 2006 plan specifically went into greater detail about how new technologies, treatments and diagnostic procedures could be strengthened to improve positive patient outcomes.4
 
Following Norway’s lead, it has become common practice for Nordic countries to implement national guidelines for treating common cancer types. For example, Sweden introduced its national clinical guidelines for breast cancer, prostatic cancer and colorectal cancer in 2007, outlining a number of initiatives within prevention, screening, diagnostic activity, treatment, rehabilitation and palliative treatment.5
 
How multidisciplinary teams can improve cancer care delivery 
When compared globally, cancer care in Sweden is of a high standard due to the country’s relatively good outcomes in terms of lower mortality and longer survival rates. One of the reasons for this is because in Sweden there is an increasing trend towards national cooperation and centralisation of cancer care,6 with 21 different county councils, and their multidisciplinary approach to caring for patients. 
 
Multidisciplinary team management has brought about an integrated healthcare approach, replacing the referral process where a patient was sent from one clinician to another at various stages of diagnosis and treatment, which was often an overwhelming and unsatisfactory experience for the patient.
 
Multidisciplinary teams are composed of different professionals that possess a variety of skills necessary to ensure safe and effective care for the patient. The positive outcomes associated with multidisciplinary teams have been proven in numerous studies, such as those carried out by the NHS in the United Kingdom (UK),7 which have demonstrated how working and learning in collaboration among different clinical professionals results in the best and most cost effective outcomes for the patients, as well as innovative practices that lead to higher quality healthcare. 
 
I have been the Senior Advisor and Programme Manager at Regionalt Cancercentrum Stockholm-Gotland, Stockholm, Sweden, for almost four years, in which time I’ve been dedicated to developing the delivery of cancer care in the region. Through my work I have realised the importance of an effective coordinated management strategy to ensure patient data is accessible, high quality and meaningful to enable better informed decisions by the different healthcare providers involved in the patient’s care so that they can provide the right treatment at the right time.  
 
As cancer care and treatment develops and evolves, the role of the multidisciplinary team will become ever more important in order to enable the sharing of the expertise and knowledge related to the various elements of that cancer care, from radiology to oncology. Here at Regionalt Cancercentrum Stockholm-Gotland, we aim to provide equitable care; everybody is supposed to have the same opportunity for good treatment. We therefore strive to put together and manage the right multidisciplinary team to ensure the right people come in at the right time during the different decision points of the patient’s journey.
 
There is increasing evidence9 that regular meetings of multidisciplinary teams contribute to improved cancer care and patient outcomes. An effective multidisciplinary team helps to ensure that patients receive timely treatment and care from appropriately skilled professionals, continuity of care and sufficient information and support.9
 
A multidisciplinary team conference, which is often performed through telemedicine due to the specialists being at different locations, provides a platform to bring in the right expertise to discuss and share information to help improve patient outcomes. Due to the success and confidence in this method, multidisciplinary teams have been established as best practice in Sweden and there is now a movement to ensure that all future national cancer care guidelines will include multidisciplinary team conferences for every patient. 
 
Multidisciplinary management solutions
Following Finland and Denmark, Sweden is in the process of issuing a national tender for a new healthcare IT system in order to, amongst other things, improve the structure of the data within the numerous regional cancer registries. Since 1958 it has been compulsory for newly detected cancer cases to be registered on the Swedish Cancer Registry, which covers the entire population and has approximately 50,000 new malignant cancer cases registered every year.10
 
Improved and structured health data would help improve and facilitate the whole cancer care process along the patient’s journey. If we can integrate and utilise structured data at the point of the multidisciplinary team conference where the experts come together to determine what is best for the patient, then we would have a better and more reliable basis for decision-making during the conference, which would not only save time and be more efficient, but would also improve patient safety.
 
I am currently involved in a national project which aims to improve the multiregional pathology and radiology processes, which provide essential information for the multidisciplinary teams. The need for accurate, accessible patient data is crucial to the effectiveness of multidisciplinary teams and, in today’s complex health ecosystem, a robust IT system underpins the aim of improved patient care and outcomes.
 
As part of this project, Regionalt Cancercentrum Stockholm-Gotland and Karolinska University Hospital signed a deal with RxEye, a Swedish cloud-based solution provider that enables diagnostic imaging networks, to roll out UK based Silverlink Software’s Multi-Disciplinary Treatment Management (MDTM) solution to improve outcomes in patients with colorectal cancer. 
 
Silverlink Software’s specialist MDTM solution was identified as a tool that could enable the exchange of patient information while also facilitating collaboration between multidisciplinary teams in real-time and from any location. Silverlink Software’s solution also met the requirement of facilitating point-of-care data insights and helping to ensure that key clinical information is captured throughout the patient’s cancer care journey, from diagnosis to follow-up.
 
Most importantly, interoperable and configurable IT healthcare solutions like those developed by Silverlink Software have the ability to integrate with and strengthen larger systems developed by multinational electronic health record vendors. Such best of breed applications therefore not only streamlines the workflow of multidisciplinary teams by capturing data along the patient’s journey, but it also speaks to other solutions to ensure further utilisation of the captured data.
 
The foreseeable future of cancer care
In April 2014 the Swedish government announced plans to invest two billion Swedish Krona in improving cancer care between 2015 and 2018,12 with a special focus on shortening waiting times and improving timely diagnosis and treatment. This financial allocation will also cover the research and investigation required from experts to develop additional cancer guidelines, which are expected to have mandatory requirements for multidisciplinary team conferences so that different treatment options could be evaluated to ensure the best treatment options for every patient.
 
In the last decade alone there has been considerable progress made in cancer care resulting in increased survival rates. And with more improvements being made in cancer care every year due to advancements in medical science, technology and secondary prevention, survival rates are only expected to increase. 
 
With the continual investment and commitment to cancer research globally, it is predicted that there will be an increasing number of cancer survivors in the system as well as an increase in cancer incidents because not only are patients surviving longer, but the population is also growing, especially the older demographic. 
 
Therefore, the need for cost effective, reliable and patient-centric working methods, such as multidisciplinary team care, and IT solutions that support those working processes need to be implemented and efficiently utilised to ensure optimal cancer care going forward.
 
References 
  1. Nord C et al. Followup of long-term cancer survivors in the Nordic countries. Acta Oncologica 2007;46(4):433–440. 
  2. Cancer Incidence in Sweden 2011. Available at: https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/18919/20…. Last accessed April 2016.
  3. A National Cancer Strategy for the Future, Report of the Commission of Inquiry on a National Cancer Strategy, Swedish Government Inquiries. Available at: http://www.epaac.eu/from_heidi_wiki/Sweden_National_Cancer_Strategy_Summ…. Last accessed April 2016.
  4. SINTEF Report: Costs of cancer in the Nordic countries. Available at: http://www.ncu.nu/Default.aspx?ID=4. Last accessed April 2016. 
  5. SINTEF Report: Costs of cancer in the Nordic countries. Available at: http://www.ncu.nu/Default.aspx?ID=4. Last accessed April 2016.
  6. A National Cancer Strategy for the Future 2009. Available at: http://www.epaac.eu/from_heidi_wiki/Sweden_National_Cancer_Strategy_Summ…. Last accessed April 2016.
  7. Team working and effectiveness in health care: findings from the Health Care Team Effectiveness Project. Available at: http://homepages.inf.ed.ac.uk/jeanc/DOH-glossy-brochure.pdf. Last accessed April 2016.
  8. Abdulrahman GO. The effect of multidisciplinary team care in cancer management. Pan Afr Med J 2011;9:20.
  9. Taylor C et al. Multidisciplinary team working in cancer care: what is the evidence? BMJ 2010;340:c591.
  10. Swedish Cancer Registry. Available at: https://www.socialstyrelsen.se/register/halsodataregister/cancerregistre…. Last accessed April 2016.
  11. Sweden tackles cancer with Silverlink and RxEye. Available at: http://silverlinksoftware.com/sweden-tackles-cancer-with-silverlink-and-…. Last accessed April 2016.
  12. National Social Report 2014 – Sweden, Ministry of Health and Social Affairs Sweden. Available at: ec.europa.eu/social/BlobServlet?docId=11676&langId=en. Last accessed April 2016.