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The Team Approach in Cancer Care

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The evolution of modern plastic surgery in the English-speaking world began with the return of Captain Gillies to the Cambridge Military Hospital, Aldershot in 1916 after two years in France. The management of severe facial injuries in a coordinated team effort continued in 1917 at a dedicated hospital in the south-east of London, again with Gillies as the mastermind. Team surgery was so successful at the Queen’s Hospital, Sidcup, that it continued as a centre of excellence after the war. Later this concept was practiced by a new generation of plastic surgeons at the Queen Victoria Hospital, East Grinstead, south of London during the Second World War. The distinguished team leaders were New Zealanders, Sir Harold Gillies (WWI & WWII) and Sir Archibald McIndoe (WWII), respectively. Other Kiwis like Mowlem, Barron, Clarkson and Manchester also applied this concept. The team approach involves division of responsibilities, leadership, clear communication, protocol-driven clinical management and always with the patient and their family as the central focus, within a multidisciplinary team. The art of medical illustration was later augmented and replaced by medical photography to record the passage of patients on their journey re-integrating into society. In advanced facial cancer prior to the 1950s, long intervals of delay in reconstruction were the standard approach, with temporary skin graft cover or dressings being applied during the intervening period. After the 1950s and based on the surgical experience of the world wars, immediate reconstruction became the norm. This was aided greatly by the emergence of antisepsis and antibiotics. Different members of the team are involved in a multidisciplinary collaborative process of establishing diagnosis, cancer staging, resection, immediate reconstruction, adjuvant therapies and rehabilitation including speech and swallowing. The team is made up of, in no particular order, surgeons, anaesthetists, nurses, psychologists, technical staff including maxillofacial prosthetists plus medical photographers, oncologists, pathologists, nutrition and speech therapists, charitable care groups and social workers and, also importantly, end of life carers. This chapter defines the multidisciplinary approach which guides the treatment for the patient in cancer care, as is the team-based approach to burn injuries and trauma. It considers the key principles and philosophies behind the modern team approach. The history of plastic surgery and the experience of tens of thousands of facially war wounded are evidence that immediate rehabilitation is the method of choice and only a holistic team effort can properly achieve this.


  • Team work
  • Protocols
  • Measuring outcome

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  • DOI: 10.1007/978-3-030-88334-8_5
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Klaassen, M.F. et al. (2022). The Team Approach in Cancer Care. In: Burton, I., Klaassen, M.F. (eds) Atlas of Extreme Facial Cancer. Springer, Cham.

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