Cancer: why is the multidisciplinary team meeting essential before choosing a treatment?

Why do several specialists sometimes need to examine the same file?

A cancer is not just the name of an organ. The strategy depends on the histological type, the stage, molecular characteristics, general health, associated diseases and the patient’s preferences. A multidisciplinary team meeting (MDT) brings together the necessary expertise around the file: medical oncology, surgery, radiotherapy, radiology, pathology and, depending on the cancer, nuclear medicine, genetics, supportive care or other disciplines.

What the MDT meeting brings in practice

The MDT meeting checks that the necessary information is available, compares the imaging with the pathology, clarifies the stage and discusses the order of treatments. For example, a tumour may be operated on straight away, require treatment before surgery, or call for radiotherapy, systemic therapy or a combination. Studies show that multidisciplinary discussion can change the diagnostic interpretation or the treatment plan for some patients.

A recent meta-analysis found an association between care discussed by a multidisciplinary team and better survival in many studies, but the size of the effect varies and observational data do not allow the conclusion that the MDT meeting alone explains all of the benefit. For the patient, the most direct value lies above all in the quality and consistency of the decision.

What is needed before an MDT meeting?

A good-quality MDT meeting needs a complete file: available imaging, validated pathology, staging, medical history and functional status. Studies of how these meetings work have identified missing radiology or pathology information as major obstacles to decision-making.

Does the patient take part in the decision?

The MDT meeting makes a recommendation, but the final decision must then be explained to the patient. Their priorities, age, other illnesses, acceptable side effects and preferences may change the choice between several medically valid options. Multidisciplinary discussion therefore does not replace shared decision-making.

For an international patient, documenting the decision

The MDT meeting report is useful for continuity of care and for a second opinion. Ideally, it should specify the data reviewed and the proposal. When the patient returns to their country, this document helps the local team understand the rationale for the treatment.

Useful questions after the MDT meeting

• What is the exact stage of the disease?
• What is the aim of treatment: cure, reducing the risk of recurrence, controlling the disease or relieving symptoms?
• Why was this order of treatments chosen?
• Is there a reasonable alternative?
• Would a molecular analysis or a second pathology review be useful?

Frequently asked questions