A conversation between Thoracic Oncologist Bindu R Potugari, MD and Thoracic Surgeon Andrew M Popoff, MD, FACS
This conversation has been edited for brevity.
Dr. Popoff: Dr. Potugari, I’m excited to talk to you about MDTs today. You and I have worked together for quite a while, and you have a lot to talk about. I’m really interested to get your thoughts on the multidisciplinary care team, its value, and how it impacts our patients.
Dr. Potugari: It’s the best care for our patients. I’m excited to talk to you about this, too.
How is the MDT approach structured in your clinic/Health System? Who are the key stakeholders involved?
Dr. Popoff: In our institution, the MDT is structured as a tumor board, so we meet formally for one hour each week or at least one hour each week. It includes surgeons, thoracic surgeons, pulmonologists, medical thoracic oncologists, radiation oncologists, pathologists and radiologists and nurse navigators.
Dr. Potugari: And nurse navigators and clinicians too!
Can you describe the roles and responsibilities of each team member? Is there someone that takes the lead in the meetings?
Dr. Popoff: The tumor board is generally led by either the lead thoracic oncologist or the lead thoracic surgeon for that meeting.
Dr. Potugari: Lung cancer management is very complex now. So in our MDT teams, we have a thoracic surgeon, thoracic radiation oncologist, thoracic medical oncologist, radiologist, pathologist and pulmonologist. Nurse navigators and other residents or fellows can also join.
Dr. Popoff: Yes, for the multidisciplinary tumor board, I think it’s customary for the lead thoracic oncologist or lead thoracic surgeon to run the tumor board. And so in our case, that would be someone like me.
What factors and information are discussed within these team meetings?
Dr. Potugari: So we typically present how the patient is experiencing symptoms, and then we actually go through with the patient about the scans, what they have done as of that day. And we also review the biopsy of the patient concerning the cancer. And we sit together and we discuss patient treatment options. And based on the treatment options, we come up with a consensus which agrees with the team – the entire team.
Dr. Popoff: I agree completely. The case presentation is usually done by the physician who’s caring for the patient at the time, and it begins with a brief summary of the patient’s clinical condition and then review of imaging pathology and then a discussion about the treatment plan for that patient’s cancer.
Can you elaborate on what the MDT approach looks like in the treatment of lung cancer, highlighting specific instances or scenarios that showcase their impact? How does this case or approach deviate from a standard and/or routine case?
Dr. Popoff: I think as more and more data comes to light about multimodality treatments, the treatment of lung cancer in the modern era demands a multidisciplinary approach. So the importance of each individual physician’s contribution to the team has probably never been greater than it is now.
Dr. Potugari: At our institute, Henry Ford Cancer, we actually have a multidisciplinary meeting that is scheduled once a week for about one hour. All the teams that are related to lung cancer are actually sitting there together during that one hour. We go through and discuss each patient.
How has MDT discussions changed to include patients who were previously excluded from routine or standard considerations?
Dr. Potugari: Lung cancer management is becoming more complex. We definitely involve other specialties also. So multidisciplinary meeting time actually helps us to bring all the disciplines to one place, which can help us in shortening the time to be reviewed by the other specialties and help us in coming up with a consensus treatment plan for that particular patient.
Dr. Popoff: I think also part of the value of the multidisciplinary team is that we have the good fortune of having a really close and collegial relationship with specialists, thoracic surgical oncologists, thoracic medical oncologist, thoracic radiation oncologist, etc. So I think a result of that is that the patient has a team of physicians focused on the care of their lung cancer.
Are there any specific roles or specialties that you incorporate into the team that perhaps you didn’t previously rely on?
Dr. Potugari: I’d say Psycho Oncology and palliative care team, especially for the stage four lung cancer.
Dr. Popoff: Yes, that’s true. We had the good fortune of having a fairly comprehensive team to begin with.
How have MDT discussions changed to include patients who were previously excluded from routine or standard considerations?
Dr. Popoff: So I think for some of the early stage patients who may have just gone straight to surgery in the past, there is an increasing likelihood that they’re going to be presented in a multidisciplinary format, to decide about whether or not neoadjuvant multi modality treatment strategies like chemo, immunotherapy, or a perioperative strategy is appropriate for them.
Are there any instances that MDT communication sharing has been difficult? Do you feel this may limit your autonomy?
Dr. Potugari: That’s a difficult question to answer because the majority of the time, we actually agreed with the multidisciplinary team consensus. Have you come across challenges, Dr. Popoff?
Dr. Popoff: A time when there’s a real disagreement? I think that’s very rare. The discussion amongst the disciplines present at the tumor board is almost always sufficient to hash out what’s the most appropriate treatment plan for the patient. That’s part of the value of the team: when you have that kind of discussion, you can arrive at a consensus and hopefully that means that everybody is comfortable with the treatment approach for that case and that patient.
Dr. Potugari: After one meeting, I ended up calling my colleagues to clarify about what was discussed in the tumor board, which is a unique opportunity because of the friendly nature which we established through the multidisciplinary clinics.
Dr. Popoff: I think that’s a great point. We use a template to document what the tumor board, what information was reviewed for each case, and what the consensus opinion was regarding the patient’s cancer. There’s always the opportunity to have a more in-depth discussion with your colleagues, after the tumor board, about the details of the treatment plan. I’ve never felt like the multidisciplinary approach to lung cancer care has in any way limited my autonomy or curtailed the way in which I would treat a patient. Lung cancer in 2024, as you said, is an increasingly complex world as the clinical trial data continues to come forth. And so these kinds of discussions and this kind of team approach is going to be increasingly viewed as the standard of care, if not already.
Is there a way that providers can engage in collaboration and communication within MDT efforts if they are unable to attend virtual or in-person meetings due to time constraints?
Dr. Potugari: Yes, I can actually share an example that has happened. So one of my patients was discussed in the Multidisciplinary tumor board. Where the interventional pulmonologist was not available. He ended up calling me about what was discussed, and asking why we were doing a repeat biopsy. So I had a chance to explain about the tumor board recommendation. So he was convinced and then he was able to proceed with the procedure. So just the multiple disciplinary team actually established a good relationship with our other disciplines. It’s very convenient for them to reach out to us.
Dr. Popoff: That’s a great point. I think if you have wonderful communication in the team environment, it can be a lot easier to pick up the phone when you have a question – or if you can’t be present that week.