The
increasing burden of advanced cancers necessitates evolving comprehensive,
collaborative, and patient-centred care models. This frequently leads to
complex and multifactorial symptoms, including pain, functional decline, and
psychosocial distress, all of which significantly impair quality of life (QoL).
Providing symptomatic management and palliation to these patients requires a
nuanced understanding of the underlying disease processes and targeted,
individualised goals of care.
Diagnosis and
management of advanced cancers are often complicated by overlapping clinical
presentations and complex disease trajectories. In such
settings, effective palliative care often requires interdisciplinary
communication, integrating expertise from various healthcare professionals to
diagnose and address each patient’s complex needs.
Within this
context, radiology plays a crucial role by providing diagnostic clarity,
identifying the underlying causes of distressing symptoms such as pain or
neurological dysfunction, and assessing disease progression. The interpretation
of radiological imaging findings must be carefully aligned with the patient’s
clinical status and palliative goals, facilitating judicious and timely
decisions that optimise comfort and function.
The impact of
multidisciplinary radiology consultations has been highlighted in oncology
settings, impacting and guiding the plan of care for cancer management
[1,4,8.9,10,11,12]. Dana Guyer et al. observed that a biweekly palliative care
conference led to medication changes in 50% of patients and referral for
interventional or radiation procedures in 26%, highlighting its utility in
managing pain and symptom burden [2]. However, a systematic review by Brindha
Pillay cautioned that while Multidisciplinary team meetings (MDT) influence
diagnosis and treatment, evidence supporting improvements in patient-centred
outcomes, such as QoL, remains limited, advocating for more targeted research
in this area [3].
Despite these
promising findings, few studies have specifically examined the impact of
radiology consultations on quality of
life and symptom burden
in palliative care populations. A randomised controlled trial by Mitchell et
al. is among the first to report that case conferences involving general
practitioners and palliative specialists positively influence quality of life
(QoL), especially as patients become more seriously ill [6]. These findings
suggest that multidisciplinary discussions—evaluable those involving radiologic
input—may significantly improve patient outcomes in palliative care; however,
further evidence is needed.
Recognising
the value of radiologic expertise in the palliative setting, the Department of
Onco-Anaesthesia and Palliative Medicine at Dr BRAIRCH, AIIMS, New Delhi, has
integrated structured radiology discussions/consultations into routine clinical
care. These interdisciplinary meetings involve the collaborative review of
imaging studies in the context of each patient’s clinical background, allowing
for real-time discussions between palliative medicine physicians and radiologists.
This initiative has enhanced clinical insight, improved management precision,
and fostered a culture of shared learning and continuous quality improvement.
This
observational, descriptive study aims to fill this gap by evaluating the impact
of radiology consultation conferences on the quality of life of patients with
advanced chronic diseases who receive palliative care. By assessing changes in QoL
and symptom burden before and after such consultations, this study aims to
contribute to the growing body of evidence supporting integrated palliative
care models.
REVIEW OF
LITERATURE:
Impact
of radiology conference on patient management:
This prospective study by O.R Brook et al. concludes
that consultation at a radiology conference in a tertiary centre led to major
changes in the management of 37% of the cancer patients presented and provided
important information regarding the patient’s disease in up to 50% of patients.
A major change in management occurred following the discussion at the
conference in 37.3% of the patients. A minor change occurred in 14.9%, and the
treating oncologist reported no change in management in 47.8%. Presentation and
discussion during the conference contributed significant new information in
49.3%, and new information of lesser importance was added in another 35%.
Additional imaging was recommended in 28.45% of the cases presented at the
conference.[1]
Impact
of multidisciplinary team meetings on patient management:
In a narrative review by Dana Guyer et al., it was found
that, among the 68
patients presented, the most frequently discussed cancer was breast cancer,
followed by lung cancer. A total of 18 patients (26%) were referred for the procedure,
including 7 patients (10%) for radiation, 11 patients (16%) for interventional
procedures, and 34 patients (50%) had medication changes as outcomes of the
meeting. It concludes that the development of a biweekly palliative care
conference modelled after traditional oncologic tumour board meetings allows
patients to be discussed in a multidisciplinary setting and commonly results in
changes in the management of pain and other cancer-related symptoms. [2]
A systematic
review by Brindha Pillay concluded that Multidisciplinary team (MDT) meetings
impact patient assessment and management practices. However, there was little
evidence indicating that MDT meetings improved clinical outcomes. Future
research should assess the impact of MDT meetings on patient satisfaction,
quality of life and cross-referral between disciplines. Although MDT meetings
seem intuitively beneficial, the current research demonstrates limited support
for the positive impact of MDT meetings in oncology settings. Thus, until a
stronger evidence base develops for MDT meetings, it may be prudent and more
cost-effective to discuss particularly difficult or controversial cases rather
than the universal inclusion of patients for MDT discussion. None of the
studies reviewed evaluated how MDT meetings impacted patient satisfaction or
quality of life. Patients may experience a sense of satisfaction or well-being
if they are involved in decision-making during the MDT meeting process [3]
A
retrospective study by Newman et al. showed that A review of the imaging
studies resulted in changes in interpretations in 67 of the 149 patients
studied (45%). This resulted in a change in surgical management in 11% of
patients. In conclusion, a multidisciplinary review can provide patients with
useful additional information when making difficult treatment decisions. [4]
A study by
Rao, Kenny et al. concludes that the Uro-oncology Multidisciplinary Meeting
(MDM) alters management plans in about one-quarter of cases. MDMs also serve
other purposes, such as cross-referral or consideration for clinical trials.
Patients should be discussed in MDMs if multimodal therapy may be required,
clinical trial eligibility is being considered or if metastasis or recurrence
is noted. The MDM led to high-impact changes in patient management in over a
quarter of cases, particularly for those with metastatic disease. In addition,
the MDM also plays important roles in validating management decisions,
cross-referral and trainee education. [5][3]
A randomised
control trial by GK Mitchell et al. claims to be the first study to measure QoL
outcomes for case conferences in palliative care patients, studying whether
case conferences between general practitioners and specialist palliative care
services improve quality of life. The study draws two conclusions: as the
patient becomes more ill, the impact of case conferences increases, and the
teleconference process used in this project has inherent weaknesses compared
with normal communication methods in the short term. Longer-term use of
teleconferences may yield improved results as participant familiarity
increases. Case conferences in palliative care probably make a difference and
should be considered as a routine part of care.[6]
A prospective
descriptive study by Raj Krupad et al. concluded that A multidisciplinary team
approach affects the diagnostic and management decisions in a significant
number of patients with a newly diagnosed urologic malignancy, and thereby seems
to have a dramatic clinical impact for many of our patients with urologic
cancers. Changes are observed in a significant number of patients regarding diagnosis
(14%) and more often (and perhaps more relevant) treatment recommendations
(32%). The growing application of multimodal therapeutic approaches would
suggest an ever-increasing relevance to this multidisciplinary approach to patients
with a genitourinary malignancy. [7]
A
retrospective chart review study by Heather O Greer et al. concluded that of
215 radiology presentations in a multidisciplinary tumour board, 89% were
reviewed to confirm recurrent or persistent disease; malignant disease was
confirmed 74% of the time. A review of imaging studies results in a new
diagnosis or upstaging 10% of the time. A multidisciplinary tumour board allows
a wide range of gynaecologic diagnoses and clinical scenarios to be discussed. Most
radiology reviews were presented to confirm persistent or recurrent cancer
before recommending further therapy. [8]
Impact of
multidisciplinary team meetings on goals of care discussion:
Soon et al.
(2023) did a prospective cohort study to analyse cancer patients undergoing
palliative surgical interventions with a multidisciplinary Palliative surgical intervention
(MD-PALS) team. An ITS (Interrupted time series) model was built to evaluate
MD-PALS implementation effects on the quality of the goals of care discussion
using a four-point composite score, and it was found that the MD-PALS team
improved the quality of the GOC discussions conducted.[29]
Quality of
life in Palliative care patients:
In a
systematic review by D Gayatri et al., it was found that cancer patients in
palliative care units in developing countries generally experience poor quality
of life due to late diagnoses, inadequate symptom control, and limited access
to care. However, palliative interventions showed notable improvements,
especially in physical and emotional well-being. [30]
Gonçalves F
et al. did a Cross-sectional, descriptive, correlational study, which revealed
a positive correlation between overall symptom severity and a perceived
deterioration in quality of life, well-being, and quality of care. Higher
symptom distress is significantly associated with poorer QoL. These findings
highlight the importance of early symptom control in improving life quality in
palliative oncology settings. They recommended including non-cancer palliative
patients in similar studies to obtain valuable insights. [31]
Impact of
second opinion interpretation of imaging in various settings:
A
retrospective study by Yulia Lakman et al. indicated that a second-opinion
review of GynOnc (Gynaecologic Oncology) MRI by sub-specialised radiologists
can impact patient care and allow for more informed medical decision-making.
According to the opinions of experienced gynaecologic oncologic surgeons, the second-opinion
review would have changed some aspect of clinical management in at least one-fifth
(20–21.5%) of patients, led to a change in the treatment approach for
12.8–15.1% of patients, prevented unnecessary surgery in 6.6–7.5% of patients,
improved the surgical approach in 2.5–4.1% of patients, and replaced a
non-operative management strategy with a more appropriate, surgical
intervention for 1.9–2.3% of patients. They insist that second-opinion
consultations should be considered a valuable and reimbursable clinical
service. [9]
In a randomised
retrospective review by John T. Lysack et al., it was concluded that more than
half of patients with head and neck cancer had a change in the clinical stage
following a second opinion review of their outside imaging studies, and this
led to a change in management in greater than one-third of patients. In
patients with a biopsy-proven or clinically suspected malignancy, subspecialty
radiologist interpretation of imaging studies positively impacts patient
care.[10]
A retrospective
study by Vaios Hatzoglou et al. found that among the 283 cases, there were
55 neuroimaging studies with disagreements (19%) between the initial outside
report and second-opinion interpretation. Patient management and/or disease
stage would have been altered in 42 cases (15%) based on report differences as
determined by two neuro-oncologists and the surgeon participating in the
study.[11]
Weinfurtner
RJ conducted a retrospective chart review study and concluded that second
opinion evaluation discrepancies were seen in 287 (57%) patients, resulting in
percutaneous image-guided biopsies in 92 (18%). Forty-five additional sites of
cancer were biopsy-detected in 41 (8%) patients, including 20 breast
malignancies and 25 axillary metastases. Another nine biopsies yielded
high-risk pathology. Second-opinion interpretations altered surgical management
in 66 (13%) patients. Although additional imaging and resources are required,
second opinion radiology review by subspecialised breast radiologists increases
cancer detection and results in clinically relevant changes in patient
management.[12] |