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New system kicks up a storm at RCC (thehindu/)

Radiation oncologists oppose multidisciplinary tumour boards

An internal dispute at the Regional Cancer Centre (RCC) over the government’s decision to introduce multidisciplinary tumour (MDT) boards in place of the cancer site-specific clinic system is threatening to disturb the fragile peace in the institution, which has been witnessing a lot of internal and administrative issues of late.

On Monday, the entire Department of Radiation oncology marched to the office of RCC Director Paul Sebastian in protest against the “sudden” decision of the administration to change the treatment plan and system, which they said had been the norm since the inception of the centre.

The Superintendent, Deputy Superintendent, Head of Radiation Oncology Department and doctors holding the posts of chairmen of the Ethics Committee Institutional Review Board resigned their posts in protest against “ the haste” with which the decision to introduce the MDT system had been implemented.

It was on December 30 that the Director issued the order that as per the government’s directive MDTs will be constituted in the RCC, including medical oncologists, surgical oncologists, radiation oncologists and oncopathologists, with effect from January 2.

The order says the MDTs will be set up in all site-specific clinics in the RCC and that these will function as academic forums to diagnose and stage cancers and to formulate a comprehensive treatment and follow-up plan of all patients through discussions and consensus.

It says that “all registered cases every day will be distributed among the consultants attending the outpatient clinics in a judicious manner, making sure that surgical cases go to the surgical oncologist, patients for chemo radiation go to the radiation oncologist, patients for primary chemotherapy go to the medical oncologist… in a fair manner.”

Radiation oncologists said they were bothered about the manner in which the MDT was being implemented and that they had several concerns, which needed clarification from the Director. They said the current site-specific clinic system had been working well for patients without any hitches and that the administration was playing “divide and rule” amongst doctors.

“All these years, we have had the site-specific clinics and our practice has been thus confined to the management of cancers in specific sites. We are trained to give both radiation as well as chemotherapy. With the new system, radiation oncologists are being told to confine ourselves to our own specialities while the medical oncologists are allowed to see all kinds of cancers, which is not fair,” a senior radiation oncologist said.

“The MDT is an internationally accepted practice prevalent in all major cancer institutions, with improved clinical outcomes and patient satisfaction, because a group of specialists from various disciplines are coming together to decide cancer staging and formulate the treatment plan. The system is already being practised at the Malabar Cancer Centre. At the RCC, however, radiation oncologists have been at the helm of patient management so far,” Additional Chief Secretary, Health, Rajeev Sadanandan told The Hindu .

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