Implementation guidelines for multidisciplinary team diagnosis and treatment of stage IV primary lung cancer in China

Excerpt

Although patients with stage IV primary lung cancer have a variety of treatment options, due to the complexity of the disease and the heterogeneity of the disease, the problems that arise in the diagnosis and treatment process may involve multiple systems and organs throughout the body, so in the process of clinical practice, it is often necessary to cooperate with

【Keywords】Lung tumor; Multidisciplinary team diagnosis and treatment; specification

Primary lung cancer (hereinafter referred to as lung cancer) is the malignant tumor with the highest incidence and mortality in China, with about 815563 new lung cancer cases and 714699 deaths in China in 2020, and about 50% of lung cancer patients have already had distant metastases

In recent years, with the acceleration of the research and development of new anti-tumor drugs, there are more and more treatment options for patients with stage IV lung cancer, in addition to traditional chemotherapy drugs, new anti-tumor drugs such as molecularly targeted drugs, anti-angiogenesis drugs and immune checkpoint inhibitors have become the basic treatment choice for patients with stage IV lung cancer, how to choose the best treatment plan and treatment strategy for each specific patient is increasingly testing the level of

Multidisciplinary team treatment (MDT) refers to a fixed working group composed of two or more related disciplines, for a specific patient of a disease, through the form of consultation, put forward the best individualized treatment plan suitable for the patient, and the relevant disciplines alone or multiple disciplines jointly implement the treatment plan

First, the necessary conditions for the establishment of stage IV lung cancer MDT

The high incidence and mortality of lung cancer not only bring a heavy burden to China's medical care, but also promote the rapid development

Stage IV lung cancer MDT requires the following conditions:

1.

2.

3.

Construction of MDT for stage IV lung cancer

(1) Composition of professional departments

The professional departments of MDT for stage IV lung cancer should include pathology (including molecular pathology), imaging diagnosis, oncology, respiratory medicine, radiotherapy, thoracic surgery, and hospitals with conditions can invite clinical pharmacology, orthopedics, neurosurgery, interventional therapy, endocrinology, cardiology, rheumatology and immunology, geriatrics, general surgery, pain, palliative medicine, dermatology, traditional Chinese medicine, etc

Lung cancer patients should undergo accurate imaging staging before the start of treatment, and the difficulty of imaging diagnosis and the determination of whether the controversial lesion is metastatic will have a decisive impact on the formulation of disease staging and treatment plan, therefore, the diagnostic imaging physician participating in the ivory lung cancer MDT should have expertise and experience

(2) Membership composition and responsibility requirements

The MDT members of stage IV lung cancer include chief experts, consultation experts, and team assistants, and there should be a clear and specific division of labor for the responsibilities of

1.

(1) Peer-recognized advanced lung cancer professional discipline leader or authoritative expert;

(2) Have a certain administrative organization and coordination ability;

(3) It is recommended to set up 1 to 3 chief experts, who will be served by experts from major clinical departments, such as oncology, respiratory medicine, radiotherapy and thoracic surgery

The key responsibilities of MDT's Chief Expert include:

(1) The chief expert can adopt the rotation system and attend the MDT consultation of stage IV lung cancer on time, if not, the chief expert of the next rotation can be replaced in turn;

(2) Organize the development of MDT consultation for stage IV lung cancer, organize team members to conduct consultations, and form diagnostic conclusions or treatment plans according to the purpose of consultation;

(3) Formulate guidelines for the diagnosis and treatment of stage IV lung cancer MDT, and regularly improve or revise the diagnosis and treatment guidelines according to the problems that arise in the course of practice;

(4) Establish an MDT academic organization for stage IV lung cancer, and regularly supplement or update team members according to needs;

(5) Closely follow the development of the industry, and put forward strategic, forward-looking and creative implementation concepts and development plans for stage IV lung cancer MDT;

(6) To study the major theoretical and practical problems in the process of MDT consultation for stage IV lung cancer;

(7) Regularly organize academic exchanges related to MDT for stage IV lung cancer;

(8) Obtain and provide relevant resources required for MDT for stage IV lung cancer;

(9) Guide the medical institutions in the region to reasonably carry out MDT diagnosis and treatment

2.

The key responsibilities of MDT Consulting Specialists include:

(1) Submit MDT consultation medical records for stage IV lung cancer;

(2) Participate in the MDT consultation of stage IV lung cancer on time, and put forward analysis and suggestions on the diagnosis and treatment plan;

(3) Provide necessary assistance to the inter-professional diagnosis and treatment process;

(4) Guide the implementation of MDT diagnosis and treatment opinions for stage IV lung cancer and patient follow-up and summary;

(5) Participate in the formulation and revision of MDT diagnosis and treatment guidelines for stage IV lung cancer;

(6) Participate in the research of

3.
The criteria that the MDT assistant of stage IV lung cancer should meet: Generally designated by the chief expert department, it can be served by the chief resident physician, attending physician or above of the main participating department (2 to 4 people).

The main responsibilities of the MDT Assistant include:

(1) Responsible for the summary of MDT consultation medical records for stage IV lung cancer;

(2) Responsible for the collection and collation of patient data and the preliminary review of data integrity of MDT consultation patients for stage IV lung cancer;

(3) Responsible for notifying the MDT Office and filing and coordinating the participation and organization of experts in various professional departments of stage IV lung cancer MDT, and issuing and notifying the time and place of MDT consultation for stage IV lung cancer;

(4) Responsible for preparing the necessary conference-related facilities for MDT consultation of stage IV lung cancer;

(5) Responsible for reporting the detailed medical history and purpose of the MDT consultation patient;

(6) Responsible for recording the process and final diagnosis and treatment plan of MDT consultation for stage IV lung cancer, conveying the results of the consultation to patients and families, and submitting consultation records;

(7) Responsible for the backup and archiving of patient medical record data and consultation discussion documents;

(8) Responsible for the regular follow-up and summary
of patients with MDT consultation for stage IV lung cancer.

(3) Necessary facilities for MDT for stage IV lung cancer

1.
Conference venue: the conference venue should be relatively fixed, if you want to change the venue, you need to inform the team members at least 1 to 2 working days in advance; The meeting venue should be a quiet, independent space; The seating layout of the venue facilitates the display and discussion of medical records; Provide seats, medical records, scratch paper, pens, etc
.
for each member who participates in the MDT consultation for stage IV lung cancer.

2.
Equipment requirements: The conference room holding the MDT consultation of stage IV lung cancer should be equipped with computer equipment and high-definition projection equipment that can be connected to the hospital intranet in order to retrieve and broadcast the patient's imaging, histopathology, molecular pathology, laboratory examination and medical records
.
It is recommended to have computers, printers and filing cabinets
that can enter, print and store MDT consultation opinions for stage IV lung cancer.
Hospitals with the capacity should also be equipped with remote consultation equipment to facilitate inter-hospital MDT consultation
of stage IV lung cancer.

(4) Establishment of relevant systems

1.
Requirements and applications for MDT consultation patients for stage IV lung cancer: Patients undergoing MDT consultation for stage IV lung cancer should have diagnostic and therapeutic problems that require the participation of multiple professional physicians, such as special groups of stage IV lung cancer patients (such as the elderly, poor physical fitness, organ dysfunction), patients with doubts about the scope of lesions and efficacy evaluation, patients who need multidisciplinary comprehensive treatment, patients with complex lung cancer, patients with backline therapy, complex patients who still have difficulty deciding on treatment plans according to authoritative guidelines, and patients in lung cancer internal medicine or radiotherapy Patients with unintended complications in the treatment process such as intervention, patients whose pathological diagnosis and clinical features do not match
.
Inpatients should decide to apply for MDT consultation for stage IV lung cancer after rounds and discussions in their departments, and outpatients should apply for MDT consultation by physicians with experience in the diagnosis and treatment of stage IV lung cancer
.
Patients participating in the MDT consultation of stage IV lung cancer should have completed relevant auxiliary examinations, complete medical records and clear
purposes.
The attending physician should apply for MDT consultation at least 1 working day before the MDT consultation for
stage IV lung cancer.
For MDT consultations for stage IV lung cancer that require a fee, the patient's informed consent should be obtained
.

2.
Fees for MDT consultation patients with stage IV lung cancer: It is recommended that there are two forms of
MDT consultation for stage IV lung cancer, which are charged and not charged.
If the consultation is for the purpose of the patient's diagnosis and treatment decision- and the patient is fully aware of and agrees to the fee, the consultation fee
may be charged according to the provisions of the multidisciplinary comprehensive consultation payment project established by the hospital.
If the MDT consultation for stage IV lung cancer is based on academic exchanges and discussions between physicians through specific patients, it is in the form of
no charge.

3.
Consultation records of MDT for stage IV lung cancer: A dedicated multidisciplinary comprehensive consultation record for stage IV lung cancer should be established
.
The MDT consultation record of stage IV lung cancer shall be standardized to fill in the specific time and place of the consultation, the name, profession, title and other basic information
of the organizer and participant.
Patient information should include name, gender, age, medical record number or outpatient visit number, main complaint, brief current medical history, previous and concurrent disease history, histopathological diagnosis, molecular test results, staging, important abnormal laboratory and imaging test results, etc.
, to record the purpose
of the consultation.
After the completion of the consultation, the treatment opinions and plans formed by the MDT consultation of stage IV lung cancer should be completely recorded, and the consultation record needs to be signed by
all members participating in the consultation.
MDT consultation records for stage IV lung cancer should be printed in duplicate, one for the patient, one for the patient to file in the patient's medical record, and kept in the hospital's case room
.

4.
Follow-up of patients with MDT consultation for stage IV lung cancer: Specific team members should be designated to conduct regular follow-up after MDT consultation for stage IV lung cancer, including understanding the implementation of the MDT treatment plan for stage IV lung cancer, the efficacy of the treatment plan, and the observation of adverse reactions and the survival of
patients with MDT consultation for stage IV lung cancer.
Regularly analyze and summarize, and gradually improve the diagnosis and treatment level
of MDT for stage IV lung cancer.
In addition, MDT consultations
should be conducted again if necessary, based on changes in the patient's condition and new treatment needs.

Quality assurance and sustainable development of MDT for stage IV lung cancer

1.
MDT consultation for stage IV lung cancer should be fixed in time, fixed members and limited to the number of patients in each consultation: MDT consultation for stage IV lung cancer should be carried out regularly according to the number and needs of patients with stage IV lung cancer in the hospital
.
MDT members of stage IV lung cancer should be fixed and ensure that at least 1 relevant professional department personnel should participate in each MDT consultation for stage IV lung cancer, and the number of patients in each consultation should not exceed 10 cases
.

2.
Registration and summary of MDT consultation records for stage IV lung cancer: Establish MDT consultation files for stage IV lung cancer, and follow up and analyze the follow-up treatment, outcome and outcome of patients
.
Regularly summarize and feedback the implementation of the resolution on MDT consultation for stage IV lung cancer, and analyze the improvement effect on the original diagnosis and treatment mode and the impact on
the unity and cooperation of different professional departments.
The hospital medical management department shall regularly supervise and assess
the clinical implementation of patients participating in lung cancer MDT.

3.
Carry out academic exchanges and multidisciplinary collaborative research through stage IV lung cancer MDT: Through repeated in-depth and multidisciplinary participation in consultation and discussion, it will not only promote the in-depth learning of MDT members of stage IV lung cancer in this professional field, but also inevitably deepen their understanding
of other related professional fields.
Multidisciplinary collaborative research and academic exchanges are carried out through the MDT platform for stage IV lung cancer, so that the MDT model of stage IV lung cancer can be sustained and healthy.

Fourth, the establishment and implementation of the whole MDT concept for patients with stage IV lung cancer

1.
Patients with stage IV lung cancer should undergo MDT consultation
at each stage from initial diagnosis to treatment to disease outcome.

2.
MDT consultation can promote the healthy development
of individualized therapy based on molecular typing in patients with stage IV lung cancer.

3.
Patients with stage IV lung cancer should be given aggressive treatment after consultation with MDT if they can undergo surgery or radiotherapy to improve the survival time and quality of life of
patients with stage IV lung cancer.

In summary, stage IV lung cancer is a systemic disease, with the continuous advancement of treatment methods, the survival time of patients continues to prolong, therefore, patients with stage IV lung cancer often need systemic multi-system management in the treatment process, and lifelong follow-up
.
This guideline aims to assist front-line medical workers to comprehensively manage the whole process of disease in patients with stage IV lung cancer, and the specific implementation should be based on the specific conditions of their respective hospitals, and the MDT consultation mode for stage IV lung cancer that is suitable for operation in the hospital is formulated
.

Oncologist Branch of Chinese Medical Doctor Association, Oncology Branch of China Association for the Promotion of International Exchange in Healthcare.
Implementation guidelines for multidisciplinary team diagnosis and treatment of stage IV primary lung cancer in China[J].
Chinese Journal of Oncology, 2022, 44(7):667-672.

DOI:10.
3760/cma.
j.
cn112152-20211221-00959