Multidisciplinary care for breast cancer: barriers and solutions

Breast cancer treatment and research is becoming more multidisciplinary in nature. Several modalities and areas of expertise are critical for optimal patient management. The basis for medical decisions and recommendations must reflect outcomes and clinical trial data that are designed and interpreted with broad input across different fields. Hence there has been a trend for specialization in breast disease in many large community and academic practices. Furthermore, a system of communication and standardization of data values, procedures, and protocols has begun, but needs much further development. There are many natural barriers to the process of multidisciplinary care and research in terms of logistics, finances, and education. The example of preoperative neoadjuvant therapy for early stage locally advanced breast cancer is one that involves multiple disciplines in the formulation of a treatment and in future research that will define the optimal individualized approach. This process can also shed further light on biologic principles and potential for improved treatment. Solutions for overcoming barriers to multidisciplinary care should include incentives for collaborative and coordinated clinical care across disciplines. A model of increased efficiency because of pooled resources and specialization in several fields should also be accompanied by a demonstration of increased quality of care and patient satisfaction. Any process that adds to cost or inconvenience needs to be justified in an evidence-based manner. Finally, these initiatives need to be effectively communicated to the professional and policy-making communities and to the public at large through well-conceived and unbiased educational venues.