Children and Young People’s Cancer Service (CYPCS)
UCLH Primary Treatment Centre (PTC)
Teenage and Young Adult (TYA)
Multidisciplinary Team Meeting (MDT)
Document Type
Procedure(SOP) √
Policy
Guideline
Document Control Summary
TYA Cancer Measures:
11-7D-203
Version No:
2
Author(s) (name, job title,
department )
Rachael Hough, Clinical Lead CYPCS
CYPCS Senior
Staff Meeting
Approved at:
Date: 19.9.12
Director or Designee Signature:
Review interval:
2 years
UCL Hospitals is an NHS Foundation Trust incorporating the Eastman
Dental Hospital, Elizabeth Garrett Anderson & Obstetric Hospital, The
Heart Hospital, Hospital for Tropical Diseases, National Hospital for
Neurology & Neurosurgery,
The Royal London Homoeopathic Hospital and University CollegePage: 1 of 10
Document Title/Identifier: 106746028
Approval Date: Populated by QM Hospital.
Approved By: Populated by QM
Children and Young People’s Cancer Service (CYPCS)
Version Change Control Log
Please note that this document is subject to the document control of the UCLH CYPCS
Service
The following is strictly prohibited:
 Modifying or photocopying this controlled document
 Storing a local electronic or hardcopy without appropriate approval
 Removing this copy from its location without prior permission
If you feel that this document is no longer fit for purpose please make management aware
and the document will be reviewed.
Version
No:
1
Approval
Date
Populated
by QM
Comments/Changes
Populated by Author, QMG, QM
Table of Contents
1.0
Introduction ……….. .................................................................................................... 3
2.0
Abbreviations & Definitions .. ..................................................................................... 3
3.0
Scope ............................................................................................................................ 3
4.0
Stakeholders/Responsibilities .................................................................................... 4
5.0
Related Documents...................................................................................................... 4
6.0
Procedure ..................................................................................................................... 5
7.0
Limitations/ Planned Deviations ................................................................................. 8
Document Title/Identifier: 106746028
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Children and Young People’s Cancer Service (CYPCS)
1.0
Introduction
The UCLH TYA MDT has been established in accordance with the Improving
Outcomes for Children and Young People with Cancer Guidance, NICE 2005. The
purpose of the MDT is to ensure that teenage and young adult patients with cancer;
1.1.
1.2
1.3
1.4
1.5
Receive expert medical treatment for their cancer, which is appropriate for age.
Have access to appropriate clinical trials where available.
Have an allocated key worker.
Are assured of consistency of therapeutic approach between adult and paediatric
physicians.
Have consideration of their individualised psychosocial needs, based on their social
and emotional maturity.
1.6
1.7
1.8
1.9
The MDT also provides a forum for
Discussion of those cancers in TYA patients for which there is no site specific MDT.
Facilitation of transition from paediatric, through teenage to adult cancer services.
Registration on the national TYA cancer database.
Co-ordination between site specific and TYA MDTs.
2.0
Abbreviations & Definitions
MDT
TYA
IOG
PTC
3.0
Multidisciplinary Team
Teenage and young adult
Implementing Outcomes Guidance
Primary Treatment Centre
Scope
This policy applies to all UCLH TYA MDT members.
Document Title/Identifier: 106746028
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Children and Young People’s Cancer Service (CYPCS)
4.0
Stakeholders/Responsibilities
4.1
The MDT Coordinator will be responsible for
Receiving MDT referrals
Sending acknowledgment of receipt of referral within 1 working day
Sending invitation to referring clinician to attend or videoconference on date and
time their patient will be reviewed
Arranging for histopathologist/radiologists etc to be present if necessary
Preparing MDT lists for both TYA and TYA psychosocial meetings
Keeping a record of core and extended members present at each meeting
Sending written record of outcome to referring clinician and GP
Ensuring written record uploaded into UCLH CDR files
Send UCLH TYA information pack to patient
Maintaining patient list for each meeting and specific patient forms, which will be
stored in the TYA MDT folder on the shared server (Cancer_services on
‘sharefs5’ drive).
4.2
Core members or their nominated deputy (defined in the terms of reference)
Core members must be present at 2/3 of meetings
4.3
CYPCS Data Manager
Will send the TYA registration forms to the national registry after each MDT
4.4
Referring Clinicians or Keyworkers
Must send referral form to MDT coordinator at least 24 hours prior to the
meeting (2pm Tuesdays).
May attend the MDT in person or via videoconferencing
5.0
Related Documents
Improving Outcomes for Children and Young People with Cancer Guidance, NICE
2005
Document Title/Identifier: 106746028
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6.0
Procedure (Flow Diagram in Appendix 1)
6.1
Venue
MDT Conference Room, 4th Floor Macmillan Cancer Centre, Huntley Street, London
WC1E 6AG
6.2
Time
Wednesday 3.00-5.00pm
6.3
TYA Pathways
Any patient aged 13-18 years with a confirmed or strongly suspected cancer, must be
referred to the CYPCS at UCLH.
Any patient aged 19-24 with a confirmed or strongly suspected cancer, should be
referred to the TYA MDT, but may be investigated and treated either at the referring
centre or at the PTC, according to patient choice and if the referring centre is
designated to deliver network care.
Irrespective of treating centre, all patients should be re-referred to the TYA MDT in the
event of disease progression or relapse or when transition is indicated.
6.4
MDT Referral
The MDT coordinator will send an invitation to submit TYA MDT referral forms by email to all cancer clinicians and keyworkers on Fridays and Mondays each week (a
blank referral form will be attached to the e-mail).
The TYA MDT referral should be made in parallel with referral to the relevant site
specific MDT.
A TYA MDT Referral Form should be completed by the referring team and faxed or emailed to the TYA MDT Coordinator (E-mail address: ucl-tr.TYAMDT@nhs.net; Fax no.
020 3447 1841; Mobile number: 078 9214 7785) by 2pm on the Tuesday preceding the
next MDT.
The MDT coordinator will send acknowledgment of receiving the referral within 1
working day.
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6.5
Preparation for the TYA MDT
The MDT Coordinator saves the referral forms into appropriately initialled folders on
the UCLH cancer services shared server (:\\Shared\MDT\TYA MDT\PTC TYA MDT)
The MDT coordinator will prepare an electronic list of patients to be discussed at each
meeting and hyperlink patient names to the forms saved to the shared server.
The MDT coordinator will circulate the list for discussion to all MDT members via e-mail
by 5pm on the day before the meeting.
Each patient will be allocated a time slot to enable video-conferencing if required.
6.6
Process of the MDT
Each attendee will sign a register which will be stored by the MDT coordinator.
The meeting will be chaired by the PTC TYA MDT Lead Clinician or nominated deputy,
according to the meeting’s terms of reference.
Each patient will be reviewed with specific focus on;
Diagnosis and which site specific MDT has reviewed it
Whether further investigations or diagnostic review are necessary
Treatment plan and place of delivery of each treatment modality
Named consultant in charge of each treatment modality
Availability of clinical trials
Identification of the patient’s keyworker (either at PTC or referring centre)
Psychosocial needs and how these are to be met
Results of fertility discussion
Registration details
The outcome of the discussion will be typed into the allocated space on the referral
form, during the meeting. This will be projected for MDT members to review.
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6.7
Communication of Outcome of the MDT
For UCLH patients, the MDT coordinator will upload the form for each patient, stored
on the shared server, into the patients CDR file.
For patients choosing treatment at external designated hospitals, the MDT coordinator
will e-mail the referral form including outcome to the referring clinician (if an NHS.net
account is available). Otherwise the MDT coordinator will send the completed form via
conventional mail or fax.
Irrespective of treating centre, a copy of the completed form will be sent to the patient’s
GP.
The MDT coordinator will send out a UCLH TYA cancer care information pack to the
patient.
The patient will be informed of the outcome of the MDT by their keyworker or physician
who are primarily responsible for their care (either at their local hospital or the PTC).
The CYPCS Data Manager will send the TYA Patient Notification document to the
national registry, unless this has already been undertaken by the primary physician
(19-24 year olds).
6.8
Management of Differences in Clinical Opinion
There may be occasions when the TYA MDT and a site-specific MDT do not agree on
the optimal management plan. Different MDTs often express differing views and offer
different recommendations for treatment. When such differences exist, the following
step may prove useful:
All views should be heard and respected
Any decision, including differences of opinion, need to be recorded as part of both MDT
records
The treatment choice should take account of the following options if available:

An open National/international study or trial open in one or other place of care for
the condition that includes the TYA patient’s age range.

An open national/international study or trial for the condition that has been subject
to Quality Assurance review (e.g. approval by an NCRI group)

Established treatment guidelines that include the whole TYA age range

Established treatment guidelines that are based upon consensus between the
MDT members with expertise in that condition and that include the entire TYA age
range from 16-24 inclusive
In the absence of the above there should be an open recorded discussion of differing
views at an MDT meeting involving both cancer site and age-appropriate
considerations. The management plan taking priority will be that where the patient is to
receive their medical care.
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Then, as part of the routine work of the team, but after a 2-month interval each would
summarize the current data supporting their case, and then together the team write
guidelines for future cases where the disagreements are explicit to all, leading over
time to constructive suggestions and research ideas.
6.9
Governance/Operational Policy Meetings
In addition to the weekly meetings, the TYA MDT will meet once yearly to review,
agree and record operational policies.
7.0
Limitations/ Planned Deviations
On occasions the recommendation of either TYA or site specific MDT may not be
followed. This may be for a range of reasons:
If the patient fails to attend the clinic, the consultant will record that the patient has
failed to attend in the case notes. The patient’s GP will be informed. The referring
clinician and appropriate CNS should be informed of the non-attendance and will be
responsible for liaising with the patient locally. A further appointment should be offered
where appropriate.
In some instances the MDT recommendations developed with limited information will
not be appropriate due to the patient’s condition when assessed in person. A record of
these occurrences will be recorded.
In some instances the MDT recommendations may not be acceptable to the patient. A
record will be documented.
8.0
Appendices.
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Appendix A: TYA Referral and Communication of Outcomes
New patient aged 19-24 at
hospital other than PTC
New patient aged 13-24
at UCLH
Complete referral form and fax/e-mail to MDT coordinator
MDT list generated and
circulated to members
Receipt of referral and invitation
to MDT sent within 1 working day
TYA MDT Review
Outcome phone call within
1 working day
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Outcome letter
sent to
referring
clinician,
keyworker and
GP
Information pack sent to
patient
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