As first defined in the NCS, treatment must be patient cente red. To achieve the very best clinical outcomes, treat ment must also be multidisciplinary, specialized, ev idence-based and rapid. Over the last five years, the en vironment in which cancer patients are treated has c hanged beyond recognition, with the introduction of n ew facilities and treatments such as minimally invasive s urgery, Cyberknife and Hematopoietic Stem Cell and Bo ne marrow transplants.

HMC has developed 15 cancer site specific MDTs, made up of physicians, surgeons, radiologists, pathologists,nurses and oncologists with specialist knowledge and skills in a specific cancer type. The MDTs focus on the clinical,radio logical and pathological features of each individual patient and make recommendations about treatment to ensure care is tailored to individual needs. Patients, as well as being discussed at an MDT review, now have a named Patient Pathway coordinator who guides them through the Patient Pathway. This achievement must now be maintained considering the number of patients discussed at MDT meetings has almost doubled in five years​

While not complete sub-specialization has been achieved among physicians, supported by the development and recruitment of the new role of Patient Pathway coordinators. Thirteen (13) Advanced Clinical Nurse Specialists graduated from the University of Calgary –Qatar and a further seven are expected to graduate in 2017 and 2018.

To date, 14 guidelines, (11 clinical management, 3 screening and 1 urgent suspected referral), have been developed and published. These guidelines are reviewed on a bi-annual basis to reflect ongoing changes to patient care. The development of guidelines for other specific cancers must continue and an ongoing program of education seminars is required to enhance understanding and adoption of guidelines across the sector. To inform the ongoing development of guideline regulation a compliance audit should be undertaken to assess adherence and implementation of guidelines.

Peer review is a quality assurance program for MDTs that uses 'self-assessment’ by teams against national measures and an external review by clinical experts.MDTs are expected to demonstrate specific evidence of meeting required standards. Where standards are not currently being met, the teams are expected to have an action plan in place to work towards compliance in an agreed timeframe, thus ensuring ongoing development of the team and service. The results of the peer review process have been instrumental in driving improvement in relation to complete membership of all MDT teams,including the development of the breast assessment clinic , the publication of patient resources, the ongoing sub-s pecialization of care and the publication of clinical guidelines.

Similar to rapid timing to diagnosis, the speed with which a patient begins treatment is also important and wherever possible, delays should be avoided. In Qatar, the goal has been for patients to begin treatment within 14 days of d efinitive diagnosis. Despite these improvements, a small number of rare or complex cancer cases still require over seas expertise, technology or clinical trials to achieve the best outcomes. However, some patients are still trav eling abroad for treatment that could be provided in Qatar.

The International Medical Affairs Office (IMAO) has provide d significant advances in the management of patients travelling abroad. The IMAO process for ap proving treatment overseas is now uniform and requires that every application for treatment overseas pass through two layers of clinical decision making. The num ber of doctors initiating the request for a patient to travel overseas for treatment has decreased from 51% in 2013, to just 7.5% in 2015.The clinical decision making pro cess adopted by the IMAO should be considered by all a pproving authorities which together, approved over 300

applications for cancer treatment overseas in 2015. The challenge remains to convince patients that the quality of care provided in Qatar is equal to and in some instances, better than the care they are requesting overseas.

Collaborating with international organizations has been in strumental in the development of cancer services over the past five years. The foundations for the success of this partnership are centered on a robust governance Framework with agreed deliverables, which are monitored on an ongoing basis and which, ultimately are linked to payment. The three work streams of nursing, medical oncology and hematology and the department of laboratory medicine and pathology, have been the focus of the program thus far. Smaller be spoke partnerships have also been established to focus on specific clinical programs and have supported the development of excellent clinical care.

There is a lot of positive momentum to build on, howeve r there is still more to do. Continuing to raise the conf idence of patients and their families of the care prov ided in Qatar will help reduce treatment overseas. En hanced collaborations not just internationally, but also w ithin Qatar, will improve consistency of service provision ac ross all aspects of the pathway. Qatar must stay at the le ading edge of technological and service developments,

increasing access to the necessary investment and training to pr ovide new services safely within the country. Where a pati ent has to be sent overseas, it will be important to ensur e it is for the shortest period necessary, with staff in Qata r being fully involved in the process, enabling early r etu rn and quality ongoing treatment.

Priorities

• Ensuring Continued Delivery of high-quality Treatment

• Multidisciplinary care

As cancer care continues to develop and improve, there is also potential for the structure and role of the MDT to be reviewed and modified. Allowing cancer patients to be managed within the MDT via well developed, tested and inter nationally benchmarked care pathways, would allow a greater proportion of the team’s time to be dedicated to managing more complex, challenging cases. To be fully implemented, it is essential that all providers, including the private sector, are active contributors to MDTs.

A significant program of work is currently underway to digitize the MDT site-specific dataset, which will ensure all information relating to patients is held centrally, rather than on separate electronic viewing platforms. The availability of complete patient data sets will increase efficiency at the MDT meetings and enhance ongoing care once the patient begins treatment, as all diagnostic and staging data will be centrally located. The benefit will also be translated to the patient, as it will ensure all healthcare professionals involved will be fully informed of the patient’s status. Being able to digitally access uniform data sets for patien ts will provide a new opportunity to use that data to inform internal audits, educate, review and improve the working of the MDT. It is not just clinicians who can benefit however and thought should be given to enabling patients to access appropriate data through a digital application. All MDTs will be trained on digital access, entry and analysis of patient diagnostic and treatment data.

In recognition of the maturation of locally trained cancer nurse specialists, it is recommended that the focus begin to shift from solely on training new Advanced Clinical Nurse Specialists, to develop ongoing further sub-specialization of A dvanced Clinical Nurse Specialists. This will enable them to provide excellent care in their chosen specialist cancer field.

While great progress has been made in sub-specialization at both the physician and nurse levels, it is recognized that more can be done to ensure that all health care professionals are provided with continued professional development opportunities so they too can become site specific cancer specialists.