Implementation of a Multidisciplinary Model of Care for Women With Metastatic Breast Cancer: Challenges and Lessons Learned

Abstract

Introduction

The present study examined the feasibility and effects of integrating a multidisciplinary team (MDT) model of care for women with metastatic breast cancer (MBC) into a large Australian cancer center. The challenges encountered and lessons learned are described.

Patients and Methods

In the present prospective, longitudinal, mixed-methods implementation study, the MDT model included face-to-face consultations with a breast care nurse and social worker, followed by a MDT case discussion and face-to-face delivery of a personalized management plan. Data were collected to describe the cohort of women living with MBC who had attended a specialist breast cancer service and their supportive care needs.

Results

A total of 62 women with median age of 60 years (interquartile range [IQR], 37-82 years) participated. The median interval from the first breast cancer diagnosis was 5.7 years (IQR, 2.0-11.6 years), and the median interval from the diagnosis of MBC was 2.0 years (IQR, 0.9-3.6 years). The MDT care model required new resources and cross-sector participation. However, the participants indicated a preference for personalized needs assessment and care planning at the diagnosis of MBC.

Conclusions

The results highlight the challenges of implementing and evaluating an MDT care model for women with MBC. The model coordinated MDT collaboration to strengthen the delivery of complex care plans. Investment in cross-sector partnerships to optimize care coordination for women with MBC was needed.

Introduction

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death among women worldwide.¹ In 1 Australian study, 7% of patients with breast cancer had metastatic disease at diagnosis and 10% of patients with a diagnosis of early-stage breast cancer (EBC) were found to have metastatic disease within 5 years.² Patients with metastatic breast cancer (MBC), also known as advanced, secondary, or stage IV breast cancer, have a median survival of 3 years, with survival of up to 15 years reported.3, 4, 5, 6 Unlike EBC, few therapeutic standards have been recognized for patients with MBC, especially after first-line treatment.⁶

Women living with MBC have reported varied and complex supportive care needs in the physical, psychosocial, spiritual, and information domains.3, 5, 7, 8, 9, 10 It has been recognized that their needs are under-addressed by the existing models of care.¹¹ In a survey of 276 UK breast care nurses, 57% indicated that the care of patients with MBC was inadequate, mainly owing to the lack of time and resources and the need to focus on the high volume of women with EBC.¹² Compared with the care received by women with EBC, the provision of supportive care to patients with MBC has been inconsistent and often inadequate.3, 4, 5

The international guidelines for advanced breast cancer⁶ have advocated for the provision of multidisciplinary care for women with MBC. Multidisciplinary care is characterized by a collaborative approach to treatment, continuity of care, timely supportive care referrals, and care planning.4, 13, 14, 15 However, limited systematic integration and study of coordinated multidisciplinary approaches in the treatment of women with MBC have been performed.⁶

The present study was initiated by a specialist breast cancer team to address the lack of a coordinated multidisciplinary service for patients with MBC at an Australian tertiary cancer center. A structured model of care was designed in accordance with the international best practice guidelines.⁶ The cases of patients with MBC were discussed by the multidisciplinary team (MDT) to inform the development and delivery of personalized care plans through breast care nurses and social workers. The study aimed to generate evidence for the broad application of the MBC multidisciplinary model of care that could contribute to the reduction of patient-reported burden and distress associated with unmet physical and psychosocial needs. The present report describes an Australian cohort of women living with MBC, their supportive care needs, and the challenges of implementing a best practice model of care in a specialist breast cancer service of a tertiary cancer center.