All cancer patients now have to have their case presented to a Multidisciplinary Team (MDT) to sanction treatment pathways. In principle this is a brilliant idea and I was involved in setting up such oversight committees in the 1970’s. The original idea was to support the clinician AND the patient and ensure the latest treatment was being provided. Sadly, these MDT sessions have now become a gateway to ensure that a population of cancer patients is treated and not an individual. There is no choice at all as far as the patient is concerned and they do not even attend the meeting. Their advocate, their oncologist, is also shackled and cannot deviate from the decision made at the meeting unless he calls a new one. This is a real problem when dealing with cancers that are not amenable to effective therapy and patients are desperate to take any risk to survive. Whilst it is vital that maximal efficiency must prevail when resources are constrained, as in the NHS, this has filtered across to the private sector. At least, at one time a patient and a doctor could treat the individual and so long as there is oversight and a logical approach then that should be allowed – not the case in the NHS at all and now not the case in the private sector. We talk about personalised medicine and this is nowhere more important than in cancer where in fact every cancer is different. You cannot have personalised medicine and a”One Size fits All”. To resolve this and for both NHS and private cases, we need to free the 16 or so Centres of Cancer Excellence that are already in existence and let them treat patients in innovative ways but in studies involving small numbers and individuals rather than huge Randomised Clinical Trials. Treat the patient and not the population because each cancer is different. These centres would still require oversight and must publish their data, good or bad, so that complete transparency exists and the patient is protected. In the private sector, this is even more important and private units should be set up to protect the patient from the charlatans. This process should be easy and cheap to set up and the restoration of choice would be popular. To me the MDT process has gone too far and rather than supporting the patient it is dictating therapy especially in cases of unmet clinical need. This is wrong and as a retired surgeon I always treated individuals and not populations. Let’s extend that courtesy, indeed human right, to oncology. It is why I am glad we have left the stultifying bureaucracy of the European Medicines Agency but I dread the possibility that the MHRA (our regulator) will not free itself of the shackles. Let’s help it.
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