Optimizing Rectal Cancer Treatment: The Essential Role of MD Ts and Patient Choice

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• Why a Multidisciplinary Team is Non-Negotiable
• Tailoring Follow-Up Care to Recurrence Risk
• The Critical Importance of High-Volume Surgery
• Patient Empowerment: Becoming an Active Healthcare Consumer
• Overcoming Systemic Obstacles to the Best Care
• The Future of Healthcare is Patient-Driven
• The Value of a Medical Second Opinion in Cancer Care

Why a Multidisciplinary Team is Non-Negotiable

Modern rectal cancer treatment demands a multidisciplinary team approach for every single patient. Dr. Torbjorn Holm, MD, states unequivocally that a surgeon should not be allowed to treat rectal cancer without first discussing the case in an MD T meeting. This collaborative forum ensures that all treatment decisions, including the need for surgery, are made collectively by a team of specialists, including surgical oncologists, medical oncologists, radiation oncologists, radiologists, and pathologists.

This team-based strategy is the cornerstone of precision medicine in oncology. It guarantees that the treatment plan is comprehensive and considers all aspects of a patient's unique cancer profile.

Tailoring Follow-Up Care to Recurrence Risk

A key benefit of the MD T process is its ability to stratify patients based on their individual risk of cancer recurrence. Dr. Torbjorn Holm, MD, explains that not all rectal cancer patients require the same intensity of follow-up care. Some patients have a very low risk of recurrence and may need minimal monitoring, while others with a high risk must be followed very intensively.

This personalized approach to surveillance is more efficient and spares low-risk patients from unnecessary tests and anxiety. The MD T makes these critical decisions after surgery, determining the optimal follow-up strategy for long-term health.

The Critical Importance of High-Volume Surgery

Beyond the MD T, surgical expertise is paramount. Dr. Anton Titov, MD, and Dr. Torbjorn Holm, MD, both emphasize that the best treatment results are achieved when a cancer surgeon performs a high volume of a specific type of operation. For complex procedures like rectal cancer surgery, a surgeon's experience directly correlates with better patient outcomes, including higher survival rates and lower complication rates.

Patients should actively seek out these high-volume surgical units and surgeons who specialize in their specific cancer. This focus on surgical volume is a recurring theme for achieving excellence in cancer care.

Patient Empowerment: Becoming an Active Healthcare Consumer

Dr. Torbjorn Holm, MD, champions a significant shift in the patient's role, from a passive recipient of care to an active, informed consumer. He argues that the term "patient," which implies waiting patiently, is outdated. The future of medicine involves patients who demand information, seek out special treatment units, and insist on the best possible care.

This empowerment means patients must understand what constitutes "the best" in cancer treatment—namely, an MD T assessment and a high-volume surgeon. Dr. Holm believes this proactive stance will fundamentally change healthcare delivery for the better.

Overcoming Systemic Obstacles to the Best Care

Despite the clear path to optimal care, systemic obstacles often exist. Dr. Holm points out that in systems like Sweden's, there is no free market for healthcare. Governments may cap the number of operations a hospital can perform, limiting a patient's ability to choose a high-volume center.

The solution, according to Dr. Torbjorn Holm, MD, is for patient demand to drive change. If patients consistently choose the best hospitals, funding should follow, forcing less popular, lower-volume centers to improve or close. The availability of treatment must be tailored to patient needs, not bureaucratic quotas.

The Future of Healthcare is Patient-Driven

The conversation with Dr. Anton Titov, MD, outlines an exciting future for oncology. Dr. Holm envisions a system where patients use internet resources and open outcome registries to research their options thoroughly. They will be equipped with data to demand referrals to the specialists and centers with the best track records.

This transparency and access to information will create a more competitive and higher-quality healthcare landscape. The power to decide who provides treatment will increasingly shift from doctors to the informed patients themselves.

The Value of a Medical Second Opinion in Cancer Care

A medical second opinion is a powerful tool for patients navigating this new paradigm. It serves two crucial functions: confirming that a rectal cancer diagnosis is correct and complete, and verifying that the proposed treatment plan, including surgery, is necessary and optimal.

Seeking a second opinion from a different multidisciplinary team at a specialized center helps patients choose the best treatment with confidence. It is a proactive step that aligns perfectly with Dr. Holm's vision of an empowered healthcare consumer taking charge of their care journey.

Full Transcript

Dr. Anton Titov, MD: Patients must demand the best cancer treatment. Patients should be active consumers of health and healthcare.

Multidisciplinary team assessment of each cancer patient is always required in modern cancer treatment.

Dr. Torbjorn Holm, MD: Today you should not be allowed to treat patients with rectal cancer unless you discuss them in the multidisciplinary team meeting before and even after surgery. So the decision can be taken if rectal cancer patient needs some more treatment and how the patient should be followed up.

It's obvious that some patients with rectal cancer have a very low risk of recurrence. Maybe you don't have to follow them at all. Some rectal cancer patients have a high risk and they should be followed very intensively.

All of these things would be much more demanding in the future. That's why you need the multidisciplinary treatment teams. That's why you need the high volume surgical units to treat patients with rectal cancer.

Dr. Anton Titov, MD: Also initiative and activity by the patients seeking the correct treatment. Patients should understand the value of going to the cancer surgeon who really has the most experience in doing the correct surgery.

Dr. Torbjorn Holm, MD: Then we have obstacles to best treatment of rectal cancer. Because at least in the Swedish health system there is no free market. So the patient cannot go to any hospital they want to go to.

The government decides how many operations each hospital is allowed to do every year. This is a problem. But hopefully the demand by patients will solve that in the future.

So that if the rectal cancer patient wants to go to hospital then the government will pay for it. So that hospital will increase their workload. Hospitals that are not so popular will have to close down. I hope that will be the future.

The availability of treatment has to be tailored to the patient's needs. It should be the patients who decide who should treat them. Not the way it has been to date, when doctors decide who should treat the patient.

Dr. Anton Titov, MD: So patients should become true consumers of health care. For some reason the term "client" or "consumer" has had negative connotations in medicine. That's absolutely not true.

Dr. Torbjorn Holm, MD: Because "patient" means somebody who patiently awaits. That's not the way medicine is going. Future will be completely different.

Patients will demand a lot of information, they will demand to come to special treatment units. Patients will demand to have the best possible treatment. They will find out about best treatment options on the Internet and in the open registries. That would be the future.

Dr. Anton Titov, MD: Professor Holm, thank you very much for this very informative conversation. It's a very exciting area of oncology.

Rectal cancer is a difficult problem, but so much has been achieved. In our conversation today it is clear a lot more will be achieved in the future. Thank you very much!

Dr. Torbjorn Holm, MD: Thank you!