multidisciplinary care in breast cancer

A multidisciplinary approach provides optimal therapy for all women with breast cancer. The disciplines represented by the core team should minimally include surgery, radiation and medical oncology, pathology, radiology and supportive care; the woman’s general practitioner should also be part of the team. In treating younger women, the team may be expanded to include other health professionals such as a plastic surgeon, fertility expert, psychologist and/or
psychiatrist.

Survival outcomes for patients with breast and other cancers are better if they are treated by a clinician who has access to the full range of treatment options in a multidisciplinary setting (Level III).57 As for older women, the surgeon is usually the specialist clinician of first contact in the management of a younger woman with breast cancer. The need for a younger woman to have preoperative consultations with a radiation oncologist and/or a medical oncologist will depend on the planning discussions held by the multidisciplinary team. Preoperative consultation with a radiation oncologist should be considered if radiotherapy is thought to be likely.

The timing of a consultation between a younger woman and a medical oncologist should be assessed on a case-by-case basis. It is pertinent for health professionals to consider pre-operative consultation with a medical oncologist and/or gynaecologist if a woman is concerned about fertility issues (see Section 7 for more information about infertility following treatment). However, as the need for systemic therapy is usually determined by the histology of the tumour
and regional lymph nodes, it may be reasonable to involve a medical oncologist in treatment planning at a later stage.
It is pertinent for members of the multidisciplinary team to inform younger women about support services specifically catering to their needs, such as younger women’s support groups. Individual women will require a varying degree of support, ranging from practical advice about obtaining breast prostheses after mastectomy to professional counselling if they are emotionally
or psychologically distressed.