Re: Lasting lessons learnt in the radiology department from the battle with COVID-19. A reply

Sir— We thank Dempsey et al. ² for their interest in our article.¹ Shared learning at local, regional, national, and international levels during the pandemic has been a key factor in attempting to stay ahead of the curve, and hopefully, this accentuated culture continues as we transition back to regular practice.

We also conducted a retrospective analysis of numbers of 2-week wait (2WW) referrals, which account for the vast majority of referrals into our cancer multidisciplinary team meetings (MDTs). We observed a drop in 2WW referrals by 56%, 46%, and 50% for suspected breast, colorectal, and lung cancers, respectively, in April/May 2020 compared to April/May 2019. The number of cancer diagnoses showed a similar trend. Anecdotally, colleagues in other institutions around the country have experienced a similar reduction in cancer cases. We should, therefore, be mindful that there may be a resultant increased demand on 2WW and cancer MDTs in excess of pre-COVID-19 baseline in the coming months. It is essential clinical radiologists and clinical colleagues prepare as best they can, not least deciding on the most effective way to proceed with the cancer MDT, reflecting on the merits and drawbacks of the video-conferencing remote format. Local opinion in our institution on how to proceed with the cancer MDT has been mixed. An ongoing remote format via a secure online platform, in addition to maintaining social distancing during the pandemic, has the potential to facilitate direct involvement of tertiary specialist clinical teams, e.g., the stereotactic body radiation therapy service, which is not currently offered in our institution, as well as facilitating cover for leave for nominated visiting tertiary surgeons. Direct input from such services in certain cases at the time of the local MDT would potentially expedite decision-making, accelerating patient care, and avoid duplication of discussion in a separate tertiary MDT; however, there are significant advantages to holding MDTs in a face-to-face format. Principally, face-to-face meetings are much more conducive to the verbal and non-verbal communication nuances of conducting difficult discussions around diagnostic or treatment decisions in complex oncology cases, where debate may be required to ensure optimum, evidenced-based patient care. This is particularly pertinent following a recent national drive to streamline MDTs to focus on complex cases. Another recurring theme amongst clinical colleagues was that the face-to-face format is much better for reviewing radiological images. Firstly, the quality of displayed images is much higher on large projected screens rather than through a remote shared screen, often viewed on a laptop. Secondly, through attending the meeting in person, there is a greater appreciation of nuances with the presented radiological images, such as the body language of the radiologist presenting complex cases, particularly around equivocal imaging findings, which may be essential to management decisions. Finally, consultants unanimously felt that team-building and inter-personal development are much better in a face-to-face format. These factors are essential for effective multi-disciplinary team working, which consists of different specialty groups, but functions as a team to provide the whole secondary care treatment pathway for oncology patients and only convenes together in this meeting. Overall, the feeling was that moving back to a face-to-face based MDT, compliant with social distancing measures, was in the best interest of cancer patients and the most effective format for group decision making. The model described by Dempsey et al. for their larger MDTs with both members meeting in person with appropriate social distancing and live video stream, may represent a good compromise to enable shielded staff members to participate and/or receive input from more specialist services that would otherwise not have been in attendance. Such a model was already taking place in certain MDTs within our hospital prior to COVID-19. The optimal model for cancer MDTs following the COVID-19 first wave will vary, but given the expected increased demand on cancer services, cancer multidisciplinary teams need to unite, support, and encourage our members and focus on our common goal of achieving cancer-free survival and improving cancer prognosis.

Conflict of interest

The authors declare no conflict of interest.