Organization of Multidisciplinary Cancer Care for the Surgical Patient: Role of Anesthesiologists
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Purpose of Review
The purpose of this review is to describe significant recent trends or developments regarding the role of anesthesiologists in a multidisciplinary team approach to cancer care for the surgical patient. We also discuss our own institutional multidisciplinary approach as a comprehensive cancer center with high surgical volume.
Beyond the multidisciplinary team meeting concept, and local, institution-specific, or national programs, more formalized concepts and models of perioperative care have evolved. These provide a framework for robust involvement of anesthesiologists in cancer care for the surgical patient, with the goal of allowing for optimal individualized cancer outcomes.
Because of the wide-ranging nature of their perioperative expertise, anesthesiologists play an important role in multidisciplinary team cancer care for surgical patients. This role has been seen in the recent trends toward clinical models, such as the perioperative surgical home and enhanced recovery programs. Areas for future research include multidisciplinary assessment of the impact of such models on perioperative cancer outcomes through integration of data from national outcomes groups.
KeywordsMultidisciplinary team Anesthesiologist Perioperative Cancer Care Cancer outcomes Enhanced Recovery After Surgery Perioperative Surgical Home
This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
Compliance with Ethical Standards
Conflict of Interest
Elizabeth F. Rieth, Gregory W. Fischer, and Anoushka M. Afonso declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Aronson S, Westover J, Guinn N, Setji T, Wischmeyer P, Gulur P, et al. A perioperative medicine model for population health: an integrated approach for an evolving clinical science. Anesth Analg. 2018;126(2):682–90. https://doi.org/10.1213/ANE.0000000000002606 Article describing a multidisciplinary integrated program to support perioperative medicine services. CrossRefPubMedGoogle Scholar
- 2.•• Ziabari Y, Wigmore T, Kasivisvanathan R. The multidisciplinary team approach for high-risk and major cancer surgery. BJA Education. 2017;17(8):255–61. https://doi.org/10.1093/bjaed/mkx003 A discussion of important concepts of the multidisciplinary team approach in high risk surgery, with a focus on major cancer surgery.CrossRefGoogle Scholar
- 5.Van Zundert AA, Wyssusek KH, Greenland KB. In reference to is multidisciplinary team care for head and neck cancer worth it? And does a multidisciplinary approach to voice and swallowing disorders improve therapy adherence and outcome? Laryngoscope. 2018. https://doi.org/10.1002/lary.27177.
- 6.•• Della Rocca G, Vetrugno L, Coccia C, Pierconti F, Badagliacca R, Vizza CD, et al. Preoperative evaluation of patients undergoing lung resection surgery: defining the role of the anesthesiologist on a multidisciplinary team. J Cardiothorac Vasc Anesth. 2016;30(2):530–8. https://doi.org/10.1053/j.jvca.2015.11.018 A discussion of the key items relevant to preoperative evaluation for lung resection surgery, with an emphasis on a multidisciplinary approach. CrossRefPubMedGoogle Scholar
- 8.Chew MH, Yeh Y-T, Toh E-L, Sumarli SA, Chew GK, Lee LS, et al. Critical evaluation of contemporary management in a new pelvic Exenteration unit: the first 25 consecutive cases. World J Gastrointest Oncol. 2017;9(5):218–27. https://doi.org/10.4251/wjgo.v9.i5.218.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.•• American Society of Anesthesiologists. Perioperative Surgical Home (PSH) Overview. https://www.asahq.org/psh/about%20psh/an%20overview/ Accessed September 24, 2018. The American Society of Anesthesiologists website providing an overview of the Perioperative Surgical Home model.
- 12.Goeddel LA, Porterfield JR, Hall JD, Vetter TR. Ethical opportunities with the perioperative surgical home: disruptive innovation, patient-centered care, shared decision making, health literacy, and futility of care. Anesth Analg. 2015;120(5):1158–62. https://doi.org/10.1213/ane.0000000000000700.CrossRefPubMedGoogle Scholar
- 14.• Gustafsson U, Scott M, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2013;37(2):259–84. https://doi.org/10.1007/s00268-012-1772-0 A review presenting a consensus for optimal ERAS perioperative care in colonic surgery. CrossRefPubMedGoogle Scholar
- 15.•• Feldheiser A, Aziz O, Baldini G, Cox B, Fearon K, Feldman L, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60(3):289–334. https://doi.org/10.1111/aas.12651 A consensus paper presenting a unified protocol facilitating involvement of anesthesiologists in the implementation of ERAS programs. CrossRefPubMedGoogle Scholar
- 16.•• Scott MJ, Miller TE. Pathophysiology of major surgery and the role of enhanced recovery pathways and the anesthesiologist to improve outcomes. Anesthesiol Clin. 2015;33(1):79–91. https://doi.org/10.1016/j.anclin.2014.11.006 An overview of the pathophysiologic process of major surgery and how the perioperative management of patients within an ERP can improve postoperative recovery. CrossRefPubMedGoogle Scholar
- 18.•• Alem N, Kain Z. Evolving healthcare delivery paradigms and the optimization of ‘value’in anesthesiology. Curr Opin Anaesthesiol. 2017;30(2):223–9. https://doi.org/10.1097/aco.0000000000000430 A review of the implications of the evolving healthcare landscape, including the PSH and ERAS as paradigms that exemplify the current and future value of anesthesiologists. CrossRefPubMedGoogle Scholar
- 20.• Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, et al. Surgical prehabilitation in patients with cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Phys Med Rehabil Clin N Am. 2017;28(1):49–64 A review of the literature and recommendations from a panel of experts in surgical prehabilitation for patients with cancer.CrossRefGoogle Scholar
- 23.Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil. 2013;92(8):715–27. https://doi.org/10.1097/PHM.0b013e31829b4afe.CrossRefPubMedGoogle Scholar
- 24.Scott JM, Zabor EC, Schwitzer E, Koelwyn GJ, Adams SC, Nilsen TS, et al. Efficacy of exercise therapy on cardiorespiratory fitness in patients with Cancer: a systematic review and meta-analysis. J Clin Oncol. 2017;77:5809.Google Scholar
- 25.Gillis C, Fenton TR, Sajobi TT, Minnella EM, Awasthi R, Loiselle SE, et al. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: a pooled analysis of randomized controlled trials. Clin Nutr. 2018. https://doi.org/10.1016/j.clnu.2018.06.982.
- 26.West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, et al. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015;114(2):244–51. https://doi.org/10.1093/bja/aeu318.CrossRefPubMedGoogle Scholar
- 28.•• Kamdar NV, Hoftman N, Rahman S, Cannesson M. Opioid-free analgesia in the era of enhanced recovery after surgery and the surgical home: implications for postoperative outcomes and population health. Anesth Analg. 2017;125(4):1089–91. https://doi.org/10.1213/ANE.0000000000002122 An editorial discussing pain management strategies within ERAS. CrossRefPubMedGoogle Scholar
- 29.Diaz-Cambronero O, Mazzinari G, Cata JP. Perioperative opioids and colorectal cancer recurrence: a systematic review of the literature. Pain Manag. 2018. https://doi.org/10.2217/pmt-2018-0029.
- 31.•• Sekandarzad MW, van Zundert AA, Lirk PB, Doornebal CW, Hollmann MW. Perioperative anesthesia care and tumor progression. Anesth Analg. 2017;124(5):1697–708. https://doi.org/10.1213/ane.0000000000001652 A review discussing the most recent up-to-date findings, focusing on the currently available “best clinical practice” regarding perioperative anesthesia care bundle factors and their effect on tumor progression. CrossRefPubMedGoogle Scholar
- 33.Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey JN. Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol. 2014;110(2):107–14. https://doi.org/10.1002/jso.23626.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.•• Kim BJ, Caudle AS, Gottumukkala V, Aloia TA. The impact of postoperative complications on a timely return to intended oncologic therapy (RIOT): the role of enhanced recovery in the cancer journey. Int Anesthesiol Clin. 2016;54(4):e33–46. https://doi.org/10.1097/aia.F0000000000000113 A discussion of RIOT as a novel quality metric used to measure perioperative interventions in cancer patients. CrossRefPubMedGoogle Scholar
- 37.• Afonso A, Oskar S, Tan KS, Disa JJ, Mehrara BJ, Ceyhan J, et al. Is enhanced recovery the new standard of care in microsurgical breast reconstruction? Plast Reconstr Surg. 2017;139(5):1053–61. https://doi.org/10.1097/prs.0000000000003235 A study from our institution assessing the effects of a breast reconstruction ERP on postoperative outcomes. CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. 2018. https://doi.org/10.1001/jamasurg.2018.1677.
- 40.International Consortium for Health Outcomes Measurement. Improving value in cancer care study in partnership with All.Can: call for applications. http://www.ichom.org/press/improving-value-in-cancer-care-study-in-partnership-with-all-can-call-for-applications/ Accessed September 24, 2018.