What Are the Recommendations to Ensure a Successful Multidisciplinary Team in Rectal Cancer?

  • Sujay Shah
  • Pawan Mathur
  • Robert Glynne-Jones


Multidisciplinary team-working aims to ensure all patients achieve prompt access to expert advice, up-to-date treatment and holistic care from relevant professionals with specialist knowledge and skills. This is particularly relevant in rectal cancer, where preoperative radiotherapy and chemoradiation are often delivered according to clinical findings and clinical staging (particularly in terms of the MRI). There are also many different surgical options available with varying levels of radicality and implications for future function and quality of life (QOL).

Multidisciplinary team-working has now been implemented in cancer care systems throughout much of Europe, the USA and Australia and forms a core component of guidelines in all cancer care services. There is almost universal approval for this strategy, despite the fact that there is little evidence for its effectiveness in improving outcomes.

In this chapter, we review the evidence for effective MDT team-working and its impact on outcomes and discuss how the characteristics and structure of the MDT, the team culture, leaders, organisation, setting and local environment influence optimal care for the patient.


Rectal Cancer Multidisciplinary Team Clinical Nurse Specialist Team Culture Patient Experience Survey 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Day F, Pollock C, Brook C, Albus A (2010) Multidisciplinary cancer teams. Crucial for population health. BMJ 340:c2125PubMedCrossRefGoogle Scholar
  2. 2.
    Fennell ML, Das IP, Clauser S, Petrelli N, Sainer A (2010) The organization of multidisciplinary care teams: modelling internal and external influences on cancer care quality. J Natl Cancer Inst Monogr 40:72–80CrossRefGoogle Scholar
  3. 3.
    Taflampas P, Christodoulakis M, de Bree E, Melissas J, Tsiftsis DD (2010) Preoperative decision making for rectal cancer. Am J Surg 200(3):426–432PubMedCrossRefGoogle Scholar
  4. 4.
    Augestad KM, Lindsetmo RO, Stulberg J, Reynolds H, Senagore A, Champagne B, Heriot AG, Leblanc F, Delaney CP, International Rectal Cancer Study Group (IRCSG) (2010) International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams. World J Surg 34(11):2689–2700PubMedCrossRefGoogle Scholar
  5. 5.
    Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL (2006) Analysis of clinical decision-making in multi-disciplinary cancer teams. Ann Oncol 17(3):457–460PubMedCrossRefGoogle Scholar
  6. 6.
    Obias VJ, Reynolds HL (2007) Multidisciplinary teams in the management of rectal cancer. Clin Colon Rectal Surg 20(3):143–147PubMedCrossRefGoogle Scholar
  7. 7.
    Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N (2011) Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol 18(8):2116–2125, 7PubMedCrossRefGoogle Scholar
  8. 8.
    Wood JJ, Metcalfe C, Paes A, Sylvester P, Durdey P, Thomas MG et al (2008) An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team. Colorectal Dis 10(8):769–772PubMedCrossRefGoogle Scholar
  9. 9.
    Morris E, Haward RA, Gilthorpe MS, Craigs C, Forman D (2006) The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire’s colorectal cancer patients. Br J Cancer 95(8):979–985PubMedCrossRefGoogle Scholar
  10. 10.
    Birbeck KF, Macklin CP, Tiffin NJ et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457PubMedCrossRefGoogle Scholar
  11. 11.
    Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2004) Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomized trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 72:15–24PubMedCrossRefGoogle Scholar
  12. 12.
    Kane B, Luz S, O’Briain DS, McDermott R (2007) Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments. BMC Med 5:15PubMedCrossRefGoogle Scholar
  13. 13.
    National Cancer Action Team (2008) National Cancer Peer Review Programme 2004–2007. National report: an overview of the findings from the Second National Round of Peer Reviews of Cancer Services in England. National Cancer Action Team, LondonGoogle Scholar
  14. 14.
    Department of Health (2007) Cancer reform strategy. Department of Health, LondonGoogle Scholar
  15. 15.
    National Cancer Action Team (2010) The characteristics of an effective multidisciplinary team (MDT). date: 16 August 2011
  16. 16.
    Lamb BW, Wong HW, Vincent C, Green JS, Sevdalis N (2011) Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool. BMJ Qual Saf 20:849–856PubMedCrossRefGoogle Scholar
  17. 17.
    Taylor C (2008) Improving the working lives of UK colorectal cancer teams: an evaluation of the Pelican team-based training programme (abstract). National Cancer Research Institute Conference. Accessed date: 16 August 2011
  18. 18.
    Taylor C, Ramirez AJ (2009) Multidisciplinary team members’ views about MDT working: results from a survey commissioned by the National Cancer Action Team. National Cancer Action Team, London. ( Accessed date: 16 August 2011
  19. 19.
    Haward R, Amir Z, Borrill C, Dawson J, Scully J, West M et al (2003) Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness. Br J Cancer 89(1):15–22PubMedCrossRefGoogle Scholar
  20. 20.
    Catt S, Fallowfield L, Jenkins V, Langridge C, Cox A (2005) The informational roles and psychological health of members of 10 oncology multidisciplinary teams in the UK. Br J Cancer 93(10):1092–1097PubMedCrossRefGoogle Scholar
  21. 21.
    Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D (2006) MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer 94:351–357PubMedCrossRefGoogle Scholar
  22. 22.
    West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective. Lancet Oncol 9:857–865PubMedCrossRefGoogle Scholar
  23. 23.
    Olver IN, Selva-Nayagam S (2006) Evaluation of a telemedicine link between Darwin and Adelaide to facilitate cancer management. Telemed J 6(2):213–218CrossRefGoogle Scholar
  24. 24.
    Warkentin M, Sayeed L, Hightower R (1997) Virtual teams versus face-to-face teams: an exploratory study of a web-based conference system. Decis Sci 28(4):975CrossRefGoogle Scholar
  25. 25.
    Picker Institute Europe (2005) Is the NHS getting better or worse? An in-depth look at the views of nearly a million patients between 1998 and 2004. Picker Institute Europe, OxfordGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Mount Vernon Cancer CentreNorthwood, MiddlesexUK

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