The Importance of a Multidisciplinary Approach to Pediatric Oncology

The prognosis for most childhood malignancies has changed dramatically over the last two decades. Childhood cancer, once seen as an invariably fatal disease, is now regarded as a life-threatening, chronic illness. Nearly all patients have long periods of remission, and for the majority, long-term survival and cure are real possibilities, although in many cases, late treatment effects occur. This achievement has resulted from improvements in the scientific understanding of childhood cancer and the incorporation of the most recent technical and medical advances into diagnosis and treatment. However, the healthcare team must also make provision for the psychosocial needs of the patient and family, which requires excellent communication among caregivers. The patients should be seen as whole people in their own world and not as isolated individuals within the illness experience. If this is not the case, it is likely that the staff will focus exclusively on medical interventions, failing to support the patient and family emotionally. In turn, patients and families are likely to focus on the minutiae of treatment and lose perspective on the larger issues.

A life-threatening illness affects each patient and his or her family differently, while different medical situations create different challenges, both for the staff and for the patient and family. The ordeal of the moment for any individual is seen through their particular personality structure as well as their previous experiences with illness and loss. In order to deal effectively with patients or family members perceived as “difficult,” the health care team must understand the roots of this perception. It is well known that children and adolescents with cancer and their families are initially in crisis. Patients and families have had little or no time to prepare for one of the most difficult, confusing and frightening experiences of their lives. They struggle to make sense of the diagnosis, the prognosis, the medical uncertainty and the potential for the patient’s imminent death. They are surrounded by intimidating, unfamiliar technology and must trust a dizzying array of medical staff whose roles and the procedures they undertake are equally unfamiliar and intimidating. The parents are often too shocked to comprehend the information reviewed with the care team. Yet it is this initial conversation on which they must rely to make the major decisions that set the course for the patient’s entire medical plan. Patients and families who are emotionally numbed by the medical crisis must adjust to familial, educational, professional, social, and sometimes, cultural changes. This is the cause of many of the conflicts that can arise among patients, families and caregivers.

Claudia Epelman (second from right), pictured here with her team, recommends a holistic approach in dealing with young cancer patients and their families.

In general, to assess the immediate medical needs of the patient, physicians use the simple concept: “start where the patient is.” However, to meet the multifaceted needs of the patient, it is important to understand how the experience of having cancer affects the patient and his/her family, a process that requires learning about their way of dealing with problems which in turn, is based upon their beliefs, values, cultural references and social context. Ensuring that the many staff members work together as a multidisciplinary team is essential if the necessary information is to be collected and acted upon. Without the collaboration of non-medical professionals, the patient profile may provide only a partial or sometimes inaccurate view. In addition, through a multidisciplinary approach tailored to the collective needs of the critically ill patient and his or her family, caregivers can more effectively address the demands upon each team member, better define their roles, gain a more rounded view of potential concerns and conflicts, and form more cohesive working relationships. This results in enhanced overall communication and a more complete understanding of the patient and family, as well as providing patient, family and staff with support; in essence, an integrated approach to holistic patient care.

Claudia Epelman, Santa Marcelina Hospital, São Paulo, Brazil