This section provides additional information relating to the practice points. This information was not sourced through a systematic review of the literature; relevant articles were identified by the Working Group and by Cancer Australia.
Multidisciplinary care is the best practice approach to providing evidence-based cancer care. Multidisciplinary care is an integrated team approach to health care, in which medical and allied health care professionals consider all relevant treatment options and collaboratively develop an individual treatment care plan for each patient.
The Multidisciplinary care principles for advanced disease11 developed by Cancer Australia reflect the role of multidisciplinary care teams in the advanced cancer setting. These principles emphasise the importance of continuity of care, care coordination, and the involvement of the patient and their carer as appropriate, in the treatment and care planning process.
Membership of a multidisciplinary team for advanced cancer should reflect both clinical and psychosocial aspects of care. As patients with advanced cancer may have specific needs and issues relating to psychosocial impact of diagnosis and prognosis, the management of physical symptoms, quality of life and practical issues
Further information on the Multidisciplinary care principles for advanced disease is available at: http://canceraustralia.gov.au/clinical-best-practice/multidisciplinary-care
Supportive and palliative care
Patients with brain metastases have complex care needs; optimal management should not only focus on physical symptoms, but should also take into account the psychosocial burden of the disease on the patients and their carer.
A United Kingdom Taskforce on metastatic breast cancer care recommended that all patients with metastatic breast cancer have access to a specialist nurse with a skill set appropriate to the secondary cancer setting.117 A demonstration project on a specialist breast care nurse role in the Australian setting found strong support from health professionals and patients for the expansion of this role.118
The National Institute for Health and Clinical Excellence (NICE) guidelines for Improving supportive and palliative care for adults with cancer27 identifies that all patients should have access to specialist palliative care services, including in-patient and community services. Rehabilitation services are important to the maintenance of physical function, promoting independence and supporting adaptation of the patient to their condition.
The NICE guidelines also identify that psychological distress is common among people affected by cancer, and that all patients should have access to appropriate psychological support, in addition to systematic assessment at key points.
The involvement of rehabilitation and palliative care services and specialist nursing services within the multidisciplinary team supports the patient and their caregivers as treatment goals transition from curative to palliative and maximises functional status for as long as possible.119