Multidisciplinary Cancer Conferences

Primary Function

The primary function of a Multidisciplinary Cancer Conference (MCC) is to ensure that all appropriate diagnostic tests, all suitable treatment options and the most appropriate treatment recommendations are generated for each cancer patient discussed prospectively in a multidisciplinary forum.

Secondary Functions

The secondary functions of an MCC are to:

• provide a forum for the continuing education of medical staff and health professionals
• contribute to patient care quality improvement activities and practice audit
• contribute to the development of standardized patient management protocols
• contribute to innovation, research and participation in clinical trials
• contribute to linkages among regions to ensure appropriate referrals and timely consultation, and to optimize patient care

The old adage “you get out what you put into it” could be applied to Multidisciplinary Cancer Conference (MCC) meetings. If participation and commitment from the required disciplines is not received, the full benefits may not be realized.

A variety of benefits[1]Reference 1 Close reference National Breast Cancer Centre. Multidisciplinary meetings for cancer care: A guide for health services providers. 2005. OpenClose have been documented in areas where mature MCCs are established, and can include the following:

Benefits for Clinicians

• Patient care is more likely to be evidence-based, with implications both for clinical outcomes and cost effectiveness.
• All treatment options can be considered and treatment plans tailored for individual patients.
• Referral pathways are more likely to be streamlined (reduction of duplicated services).
• Educational opportunities and interaction with colleagues are enhanced.
• Meeting discussion reduces the need for phone calls at other times.
• Access to possible clinical trials of new therapies is improved.

Benefits for Patients

• Increased survival for patients managed by a multidisciplinary team
• Increased perception by the patient that care is being managed by a team
• Greater likelihood of receiving care in accordance with clinical practice guidelines including psychosocial support
• Increased access to information, particularly about psychosocial and practical support
• Increased patient satisfaction with care
• Improved timeliness of appropriate consultation and surgery, and a shorter timeframe from diagnosis to treatment

Refer to the document called A Multidisciplinary Cancer Conference Setup Checklist for information on items that should be considered when setting up Multidisciplinary Cancer Conferences (MCCs).

If you find the checklist is missing a task, email a member of the MCC Project Team at MCCinfo@cancercare.on.ca and tell us what it is.

Increasing the Chances for Success

Regional Cancer Programs with MCCs have documented several enablers that have increased their overall success, which include:

• identifying local champions with leadership qualities to drive change and gain peer support
• providing dedicated funding to support new strategies
• appointing administrative personnel, such as an MCC coordinator, to assist in the set-up and coordination of meetings
• providing adequate infrastructure such as venues and telecommunications equipment
• getting commitment and buy-in from team members
• gaining early support from senior hospital administrators
• making sure meetings are held routinely so that meeting preparation and participation becomes habitual for participants
• developing contingency plans to allow for changes in personnel and organizational structure
• making sure team members recognize the value for patients and themselves

Additional Resources

• Frequently Asked Questions: MCCs
• MCC Disease Site Attendance Criteria and Patient Discussion Guidance

General Information

These tools can be used to raise awareness and promote the uptake of Multidisciplinary Cancer Conferences (MCCs):

• An Introduction to MCCs
• Comprehensive Video: The Value of MCCs
• Educational Pamphlet (targeted at clinicians)

Multidisciplinary Cancer Conference

Provincial Videocast

The educational event was held in October 2014 to discuss the evolution of MCCs, how they have transformed cancer care, and best practice solutions to common barriers.

• Topics and time-markers for MCC Provincial Videocast

Good organization is key to a well-functioning Multidisciplinary Cancer Conference (MCC). These tools provide insight on how to conduct productive MCCs and create agendas, and tips for effective communication between team members, tracking cases and more.

Documentation

• Documenting the MCC Process: Advice
• MCC Patient Case Presentation Agenda Template
• MCC Record Template
• MCC Attendance Sign-In Sheet Template
• MCC Terms of Reference Template

Examples

• MCC Palliative Example: Peel Regional Cancer Centre
• MCC Thoracic Example: Jewish General Hospital (Montreal, QC)
• MCC Regional Example: Virtual MCC (hospitals using videoconferencing)
• MCC Regional Example: Using Technology to Facilitate MCCs

Technologies help organize, measure and monitor Multidisciplinary Cancer Conferences (MCCs). The following tools provide information on technology options that may help facilitate MCCs.

• Environmental Scan and Assessment: MCC Technology Enablers of Cancer Care Ontario’s MCC Standards
• Virtual MCC: The Role of Technology in Achieving Success
• Ontario Telemedicine Network (OTN) – Personal Videoconferencing Service

Visit the Ontario Telemedicine Network website for more information on MCCs and technology.

• Each Multidisciplinary Cancer Conference (MCC) should have a designated Chair and a Coordinator (with designated backups) responsible for overall conference management and the individual meeting process.
• Required attendance criteria for all of the disease sites are available in the document titled MCC Disease Site Attendance Criteria and Patient Discussion Guidance. Required attendance at MCCs involves a combination of representatives from medical oncology, radiation oncology, surgery/surgical oncology, pathology and diagnostic radiology. These attendees are required to be present to provide the complete range of expert opinion appropriate for the disease site and appropriate for the hospital. Nursing attendance at MCCs is preferred, but not required.
• An MCC should be attended by clinicians and other health professionals who are directly involved in the presented patient’s care.
• In hospitals that do not have all the required specialists in-house, linkages can be made through teleconferencing or videoconferencing so that participants from multiple hospitals and specialties can meet together in a virtual MCC.
• Attendance of other MCC participants will be determined by the patient case(s) presented at a meeting and can include the following: primary care physician, social services, pharmacy, nuclear medicine, genetics, dentistry, nutrition therapy, physical/occupational therapy, pastoral care, pain/palliative care, mental health, clinical trials and data management representatives, and fellows, residents and other healthcare students.
• Industry representatives (or members of the general public) should not attend the MCC to maintain patient confidentiality and ensure unbiased case review.
• Patients or their representatives should not attend the MCC to ensure unbiased case review.

This tool provides clarity and guidance on the role of nurses at Multidisciplinary Cancer Conferences (MCCs). Nursing attendance at an MCC is preferred but not mandatory.

• The Role of Nurses as Key Members of MCCs

The MCC coordinator is the “glue” of the Multidisciplinary Cancer Conference (MCC). This role can make sure everything runs as easily and consistently as possible. Without a coordinator, the risk of the MCC disintegrating is high. The coordinator is responsible for:

• creating the list of patient cases, based on the cases forwarded by individual physicians
• booking the meeting, setting up the meeting room and ensuring availability/functioning of all necessary equipment
• notifying all core members, inviting any guests, and posting in-hospital meeting notice
• recording meeting attendance
• making sure all relevant up-to-date patient information, particularly slides and all imaging (including related electronic imaging) is entered in the computer before the meeting
• tracking minimum data requirements, such as how many cases were forwarded and how many were discussed at the MCC by disease site

A designate should be assigned in case the coordinator is unavailable.

A job description template for the MCC coordinator role is available to download.

• MCC Coordinator: Job Description Template

To find out who the coordinator is for your region please contact the MCC Project Team at MCCinfo@cancercare.on.ca.

The MCC Chair is accountable to the head of the hospital cancer program for Multidisciplinary Cancer Conferences (MCCs), and may delegate/rotate the running of the MCC and other responsibilities. The MCC Chair is responsible for:

• the actual running of the MCC
• making sure all forwarded cases that have been selected for presentation are discussed within the allotted time
• encouraging the participation of all MCC members
• making sure patient confidentiality is maintained by reminding participants of privacy issues and permitting only appropriate attendance

Additionally, a designate should be assigned in case the MCC Chair is unavailable.

Individual physicians are responsible for:

• discussing with the patient treatment options and conclusions, as discussed at the Multidisciplinary Cancer Conference (MCC), and making the ultimate treatment recommendations
• committing to attend MCC meetings and to send new and any other cancer cases (e.g., recurrent cancer) from their practice that would benefit from discussion by the MCC
• forwarding the patient cases to the MCC coordinator and communicating the relevant patient information, including radiology and pathology, and the specific issue to be discussed by the multidisciplinary team, before each meeting
• presenting the patient case at the MCC (or sending a delegate to present) and maintaining patient confidentiality
• providing expert opinion from their area of expertise
• recording into the medical record the MCC recommendations, the physician-patient discussion regarding the MCC recommendations, and the patient’s final decision about their treatment

Several documents offer physicians advice on how to document the MCC process and record meeting discussions.

• Documenting the MCC Process: Advice
• MCC Record Template

The creation of a Multidisciplinary Cancer Conference (MCC) Ontario Health Insurance Plan (OHIP) billing code is a substantial milestone. This document aims to facilitate understanding and offer advice regarding use of the OHIP Schedule of Benefits for MCCs:

• MCC OHIP Billing Code – Frequently Asked Questions

Accreditation

Providing a forum for the continuing education of medical staff and health professionals is essential to foster engagement of the required disciplines at Multidisciplinary Cancer Conferences (MCC). This package provides accreditation information.

• MCC Accreditation Information Package (toolkit) for Continuing Professional Development

Medical/Legal Impacts and MCCs

For information about liability issues when participating in an MCC, email MCCinfo@cancercare.on.ca. The information provided is for educational purposes only and is not intended to be used as legal advice. It is recommended that anyone seeking a legal opinion as to the impact of MCC participation on liability receive independent legal advice.

Confidentiality of patient information is paramount. Here are a few steps to maintain confidentiality:

• Frequently remind Multidisciplinary Cancer Conference attendees of privacy issues.
• When possible, make images and patient details anonymous.
• Ensure all files (electronic and paper-based) are properly secured.
• Make sure the meeting room door is closed when holding the conference.