SP-0003 Multidisciplinary cancer care: Adding value in times of change

The complexity of cancer diagnosis and treatment, with the involvement of several medical specialties, levels of care and hospitals, makes the care organisation relevant in explaining quality of cancer care, both perceived by patients and in terms of clinical outcomes. Multidisciplinary teams (MDTs) working around disease-based tumor boards are the most appropriate way to deal with the clinical decision making, although they are implemented through different ways in the healthcare services. A review of the evidence showed the impact of this approach on improved quality of care and clinical outcomes, even though there are limitations related to the observational nature of most of these studies. Nevertheless, the implementation of MDTs is an ongoing process with different pace and approaches and other endpoints (e.g., care coordination, enrolment to clinical trials) than the clinical ones should be taken into consideration. There are deep changes co-occurring in these times and this could affect how MDTs are conceived and organized. First, the value-based health care would be discussed as an emerging paradigm in cancer care. The contribution of MDTs should consider this framework, which is focused on outcomes as assessed by patients and its associated costs. In this sense, the way patients interact with MDTs could be a relevant point, for instance with the use of PROMs, which together with the information provided by Clinical-Decision Support Systems, modify the exclusive use of medical information by healthcare professionals when making decisions. Networks are another organizational change in the way cancer care is delivered. Whatever way the collaborative networking is formulated, this approach raises some additional questions on radiation oncology due to the concentration of most of the equipment in tertiary hospitals. Radiation oncology should discuss the role they should play in this dynamic environment in which MDTs are increasingly interconnected with the larger health ecosystem (beyond the hospital setting). The need for radiation oncologists to work within the MDTs in a network to coordinate the journey of the patients through different providers and levels of care, or the need to consult expert professionals from other institutions, is a reality to be faced while preserving the involvement of all medical specialties in the therapeutic decision-making process. Finally, a third point to be discussed in the presentation will be the impact of information and communication technologies (ICTs) in MDTs work. COVID pandemic has had as a major consequence the acceleration of ICTs in daily clinical practice (e.g. through teleconsultations) and the use of hypofractionated schemes, which raises the question of how innovations are disseminated and adopted across healthcare services.