Analysis

Multidisciplinary team working in cancer: what is the evidence?

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c951 (Published 23 March 2010) Cite this as: BMJ 2010;340:c951

The Cost of the MDT

NICE guidance advises utilisation of the Multi Disciplinary Team
(MDT) in order to improve treatment standards and the overall experience
of cancer patients1. MDTs should bring together health professionals with
knowledge of diagnosis and treatment to improve communication and decision
making. Patients should therefore receive better continuity and co-
ordination of care and better advice on appropriate treatment1. Adoption
of MDTs has been rapid with less than 20% of patients with cancer in
England managed by a specialist team 15 years ago, in comparison to 80% in
2004 and MDTs are now firmly embedded as the principal ‘vehicle’ to
deliver cancer care2.
The development of MDTs is not supported by high-quality evidence3. The
2004 Manual for Cancer Services recommends that an MDT comprises of Core
and Extended members. The core members should include all consultants
involved in the elective care of a cancer patient. A register should be
taken for each MDT and consultants named on the MDT register are expected
to attend 50% of the MDTs4.
There is little published information on the costs of MDTs. We aimed to
establish cost estimates for the MDT process in a large teaching
hospital/cancer centre.

Methods

Using our electronic database (PPM) the records and attendance
registers from all cancer MDTs over a one week period were reviewed. The
health professionals attending were divided into Consultants, junior
doctors and ‘others (nursing, radiographer, pharmacy and clerical) for the
purpose of analysis.

Results

The attendance register was completed in 14 out of the 15 MDTs. The
attendance from the 14 MDTs summarised showed that 147 out of 294
consultants on the register attended, 10 of 43 junior doctors and 41 of
100 ‘others’.
The total number of patients discussed at the 14 MDTs was 431.
The total time allocated through the week for these 14 MDTs was 30 hours
(2.14 hours per MDT).
The average salary of a consultant is £115,4005, the average salary of a
specialist registrar is £56,1005 and the average band 7 nurse specialist
earns £35,0005. The average consultant works 50.7 hours a week6, the
average junior doctor should work 486 hours a week and the nursing staff
37.5 hrs.6 The approximate cost of a week’s worth of MDTs in salaries
alone can be estimated to be £15,808.8 – see appendix 1. Therefore the
average annual cost of MDTs in salaries alone is approximately £822,057.6.
In salaries alone the cost to discuss each patient is £36.6.

Discussion

Many benefits of MDTs have been suggested over the years however few
have been backed up with strong evidence7. The role of the MDT within
patient management appears to be increasing. This small audit has
estimated the salary cost of cancer MDTs within a large cancer centre to
be nearing a million pounds per year. This is likely to be a significant
underestimate of the total costs as we have only looked at salaries of
those registered as attending and the majority of junior doctors do not
appear on the register. The costs we have calculated do not include
preparation time which is likely to be considerable – particularly for
Consultants in Radiology and Pathology. And do not account for non-salary
costs.
Despite a significant lack of prospective evidence, MDTs are likely to
improve cancer care and to have other benefits including enhancing
clinical research and teaching. There are however potential downsides
which include potential breaches of patient confidentiality and a lack of
clarity over the ‘medicolegal’ implications of MDT decision-making.
This small audit has demonstrated that MDTs carry significant salary
costs. With the continuing expansion of the role of MDTs in patient
management some consideration of these costs need to be taken into
account. Further study into the necessary number of health professionals
attending, particularly with regard to the more routine cases, is needed.

References

1 – The NHS Cancer plan and the new NHS. 2004.
http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4092537.pdf

2 - Griffith C, Turner J. United Kingdom National Health Service,
Cancer Services Collaborative “Improvement Partnership”: redesign of
cancer services, a national approach. Eur J Surg Oncol 2004; 30 (suppl 1):
1–86.

3 - Tattersall, MN. Multidisciplinary team meetings: where is the
value? The Lancet 2006; 7: 886-888

4 – Manual for cancer services. 2004.
http://www.dh.gov.uk/en/Healthcare/Cancer/Treatment/DH_101998#_5

5 - http://careers.bmj.com/careers/static/advice-salary-scales.html

6 - http://careers.bmj.com/careers/advice/view-
article.html?id=20000703#ref5

7 - Anne Fleissig, Valerie Jenkins, Susan Catt, Lesley Fallowfield.
Multidisciplinary teams in cancer care: are they effective in the UK?
Lancet Oncol 2006; 7: 935–43

Appendix 1

The average number of consultants attending an MDT is 10.5 [147/14],
the average MDT last for 2.14hrs [30/14], a consultant earns approx.
£43.8/hr therefore the cost of an average MDT in terms of consultant
salary is 10.5 x 2.14 x 43.8 = £984.20. For Junior doctors it’s £34.00 and
for nurses it’s £111 giving a total £1129.2 per MDT)

All authors have completed the Unified Competing Interest form at
http://www.icmje.org/coi_disclosure.pdf (available on request from the
corresponding author) and declare that (1) CF and DD have no company
support for the submitted work; (2) CF and DD have no relationships with
companies that might have an interest in the submitted work in the
previous 3 years; (3) their spouses, partners, or children have no
financial relationships that may be relevant to the submitted work; and
(4) CF and DD have no non-financial interests that may be relevant to the
submitted work.

The Corresponding Author has the right to grant on behalf of all
authors and does grant on behalf of all authors, an exclusive licence (or
non exclusive for government employees) on a worldwide basis to the BMJ
Publishing Group Ltd and its Licensees to permit this article (if
accepted) to be published in BMJ editions and any other BMJPGL products
and sublicences to exploit all subsidiary rights, as set out in our
licence (http://resources.bmj.com/bmj/authors/checklists-forms/licence-for
-publication)

Competing interests:
None declared

Competing interests: No competing interests

29 July 2010
Christopher J Fosker
ST5 Clinical Oncology
David Dodwell
St James's University Hospital, LS9 7TF
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