Multidisciplinary Collaboration for Perioperative IO in GC/GEJC

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The implementation of D-FLOT necessitates enhanced multidisciplinary coordination while building upon existing collaborative care models already established for FLOT delivery. The critical role of specialized team members extends beyond physicians to include dedicated gastrointestinal oncology pharmacists who provide essential patient and family education about medication management, adverse effect mitigation, and supportive care measures like antibiotic prophylaxis and steroid administration. These pharmacists also serve as valuable educational resources for oncologists, helping optimize treatment delivery and patient safety. Nurse navigators and infusion nurses play indispensable roles in patient care coordination and day-to-day management of treatment-related issues and complications.

Nutritional support becomes even more crucial with intensive perioperative therapy, as weight loss directly correlates with increased surgical complications and reduced ability to complete planned treatment intensity. The availability of infusion centers for supportive care allows for proactive management with hydration, steroids, and antiemetics on an as-needed basis, helping maintain patients through challenging treatment periods. Social work involvement addresses the broader support systems necessary for patients undergoing months of intensive therapy followed by major surgery and additional adjuvant treatment.

The multidisciplinary approach will likely harmonize practice patterns around D-FLOT as the new standard, potentially requiring some adjustment in team coordination and resource allocation. However, institutions already providing high-quality perioperative FLOT care possess the foundational infrastructure and expertise necessary for successful D-FLOT implementation. The enhanced complexity of care is manageable within existing frameworks, particularly given that most centers already see these patients in multidisciplinary clinics. The key is leveraging existing team expertise while ensuring all team members understand their evolving roles in delivering this more complex but more effective treatment regimen to optimize patient outcomes.