Highlighting the Importance of the Multidisciplinary Care Team in Skin Cancer Care

Non-melanoma skin cancer (NMSC) represents 80% of all skin cancers. The most common types of non-melanoma skin cancers are basal cell carcinoma and cutaneous squamous cell carcinoma. Results of a recent study of elderly patients showed that approximately 5% of patients with skin cancer are diagnosed at an advanced stage. As patients age, they may be too fragile to receive curative treatment or have multiple comorbidities and contraindications for surgery or general anesthesia.

One of the most important things that health care providers can do is coordinate treatment for these patients. Multidisciplinary teams in non-melanoma skin cancer care can help determine the best care plan for each patient and improve the quality of care. A patient with NMSC is likely to receive care from a dermatologist, surgeons, and oncologists (medical, surgical, and radiation), as well as a primary care provider.

To further examine this, the Association of Cancer Care Centers (ACCC)—with its project partner the AIM at Skin Cancer Foundation, and with support from Regeneron—launched an education program called Care Coordination for Advanced Non-Melanoma Skin Cancers. The program seeks to support earlier referrals and better patient outcomes through productive relationships between the oncology and dermatology care teams.

As a part of this initiative, ACCC’s partner, AIM at Skin Cancer Foundation’s Krista Rubin, MS, FNP-BC, spoke with Soo Park, MD, medical oncologist at the Moores Cancer Center at the University of California in San Diego, CA. Ms. Rubin is a nurse practitioner who specializes in treating people with melanoma and other skin cancers at the Massachusetts General Hospital and Cancer Center in Boston, MA.

Ms. Rubin: Talk about the evolution of multidisciplinary care. Why are we hearing so much about it?

Dr. Park: It has been around for some time, but probably only in select specialties. Certain cancers historically have always utilized surgery and radiation, and perhaps some type of intravenous treatment. Now, we have more drugs approved. We know how to treat cancer better and help patients live longer. We have been able to bring multidisciplinary care into nearly every cancer field. So, it’s a new field but not a new idea.

Ms. Rubin: Who makes up a multidisciplinary care team? Which members are always on the team, and which are sometimes a part of it?

Dr. Park: The core team consists of a medical oncologist, a surgeon, a radiation oncologist depending on the cancer, a pathologist who helps look at the patient’s tumor under the microscope, genetic counselors, nurses, social workers, pharmacists, and nutritionists. Each person plays a big part in the patient’s care.

Ms. Rubin: Walk us through the patient experience at your institution when they see you.

Dr. Park: Many patients that I see get referred to me directly, or we discuss them at our multidisciplinary tumor board. That’s a setting where medical oncologists, surgeons, radiologists, and pathologists attend. For skin cancers that occur on the head and neck, it is important to have everyone there. Then, we can look at the tumor and see what is happening. At these meetings, we will discuss the patient and preemptively develop the plan. When I meet them, I sometimes change the plan depending on what I learn about the patient and their goals. Sometimes, there might be barriers. I try to get everything in line to talk to the other physicians and make a collective plan for the patient.

Ms. Rubin: Does a patient have a role on the multidisciplinary team?

Dr. Park: The patient is an active participant along with us. We want them engaged in their care because we want to make a decision that will achieve the best treatment outcome and honor what the patient wants. We need to understand their expectations so that our clinical goals align. Quality of life is really important to many of our patients. We want to preserve that as much as possible with the treatments or procedures that we are recommending.

Ms. Rubin: Have you had patients request a multidisciplinary approach? For example, should they request a multidisciplinary approach for a newly diagnosed case of a complicated squamous cell carcinoma?

Dr. Park: Yes. In the past 2 to 3 years, the field has seen really exciting treatment advances in nonmelanoma skin cancer, such as cutaneous squamous cell carcinoma. Multidisciplinary care is advised because you never know what a different team member might recommend and how that might alter your treatment trajectory and be better for you. It is a patient’s right to request a multidisciplinary review. I would encourage this for the patient as an active participant in their own care.

Ms. Rubin: Are there disadvantages to a multidisciplinary approach?

Dr. Park: No, I do not think so because cancer care is becoming increasingly complex every day. There are new treatments coming every day and we are able to learn from each other to provide the best care to the patient. Ultimately, we want to improve outcomes and want to meet the patient’s goals.