Kuang-Hua Huang, PhD

	To improve the quality of care, multidisciplinary team (MDT) care was implemented in Taiwan. This study examined the relationship between MDT care and emergency department (ED) visits for lung cancer patients.

	A retrospective cohort study with MDT care participants and matched a double number of control group of non-participants was followed.

	In this study, 22,817 patients with newly diagnosed lung cancer were recruited from 2005 to 2007 in Taiwan. Matching based on the propensity of receiving MDT care was used. A total of 8172 patients were observed in this study. A c2, ANOVA, logistic regression, and Poisson regression were used to elucidate the effects of MDT care.

	The lung cancer patients participating in MDT had lower risk to visit an ED (OR = 0.89; 95% CI, 0.80-0.98), and the incidence rate ratio decreased by 11% (95% CI, —0.15 to –0.07). Gender, monthly salary, urbanization of the residence area, comorbid conditions, catastrophic illness/injury, treatment method, number of outpatient visits, length of stay,

	hospital ownership, level of hospital, and the age of the patient’s physician were all significantly related to the frequency of ED visits (P <.05).

	The frequency of ED visits of patients with MDT care was lower than that of those without it. The patients with MDT received enhanced care.

Multidisciplinary team care can improve the effectiveness of care for lung cancer 

The incidence rate ratio of emergency department (ED) visits decreased 11% for lung 

cancer patients participating in MDT care.

The primary cause of ED visits was fever for both the MDT participants (25.46%) and 

Worldwide, lung cancer is the most common cancer 

in terms of both incidence and mortality. In 

2012, there were 1.8 million new cases and 1.59 

has been the leading cause of cancer death in Taiwan 

diagnosis and treatment of lung cancer, both the incidence 

and mortality rate of lung cancer have increased in recent 

years. Formal multidisciplinary team (MDT) care has been 

widely promoted worldwide to improve coordination, communication, 

and decision making in cancer management.

The Taiwan bureau of National Health Insurance has implemented 

“multidisciplinary team care for cancer patients” 

since April 2003 to enhance the quality of cancer diagnosis 

and treatment. The bureau emphasizes an MDT approach 

that provides a complete cancer treatment plan for patients. 

MDT care goes beyond such conventional treatments for

lung cancer as surgical excision, radiation therapy, and chemotherapy. 

The MDT members can include related clinical 

physicians, nursing staff, a psychological consultant, a social 

worker, and a case manager to discuss a dedicated treatment 

plan and to integrate all treatments and care. Therefore, 

the patient with MDT care should benefit from stable and 

continuous care that includes regular outpatient visits and 

inpatient treatment, all arranged and coordinated through 

the case manager. The Bureau of National Health Insurance 

(NHI) paid additional fees to physicians to make MDT care 

The MDT approach has been used for years in numerous 

countries. Studies from the United States, Germany, the 

United Kingdom, and Australia have demonstrated that an 

MDT that integrates surgeons, tumor physicians, radiology 

physicians, psychologists, physiatrists, and dietitians can improve 

the quality of life for cancer patients,5 lower the cost 

 and increase the satisfaction of treatment for 

Taiwan, Wang et al found the relative risk of death was lower 

for oral cavity cancer in MDT care participants.

al found that chronic kidney disease patients who participated 

in MDT had a better survival rate than nonparticipants 

have initiate renal replacement therapy instead of 

Hospital emergency departments (EDs) are typically designed 

to manage emergent or unexpected situations and 

in North Carolina in 2008, 0.9% of ED visits were cancer 

related; 7.7% of the state’s cancer survivors visited the ED; 

and each ED visitor received 1.4 ED services per year on 

 In Taiwan, in 2012, 1.9% of ED visits were cancer 

 The reasons cancer patients seek ED services 

include pain, dyspnea, nausea, and vomiting, among others. 

13,15 Among cancer patients, lung cancer patients are, 

as a group, the likeliest of all to seek ED services.13 The 

main reasons that prompt the visits of lung cancer patient 

to EDs include respiratory symptoms, fever, neurological/ 

psychiatric issues, and digestive complaints.

The high percentage of ED visits for cancer patients 

has been recognized as an indicator that end-of-life cancer 

care is of less-than-ideal quality. Better care, it is believed, 

could help cancer patients avoid at least some of the urgent 

medical problems that necessitate ED visits. 

Articles

Impact of multidisciplinary team care on reducing utilization of emergency department visits for patients with lung cancer.

Kuang-Hua Huang, PhD

Articles

Effects of Multidisciplinary Team Care on Utilization of Emergency Care for Patients With Lung Cancer