Building the Urologist-Medical Oncologist Care Pathway for NMIBC

In this video, Alexandra Drakaki, MD, asks Mark D. Tyson II, MD, MPH, to describe the patient journey once a medical oncologist becomes involved, and what he needs to keep that coordination running smoothly. Tyson describes working within a vertically integrated health system, where he can text a medical oncologist colleague directly and often get a same-day meeting with the patient. He frames the urologist's role as the gatekeeper for surveillance cystoscopies, disease assessment, and imaging, while relying on medical oncology for drug administration and management of immune-related adverse events, noting that although some urology groups manage durvalumab (Imfinzi) themselves, he prefers partnering with a specialist trained specifically in those toxicities.

Asked what a successful multidisciplinary team looks like day to day at an academic center, Drakaki describes UCLA's model, in which urologists and medical oncologists are physically paired, seeing patients in adjoining rooms and walking through cystoscopy findings together. She highlights the gratification of seeing outcomes she contributed to in real time, and describes training the next generation of urologists, many of whom will practice in the community, to feel comfortable administering immune checkpoint inhibitors. She also points to the role of advanced practice providers and nurse navigators in catching symptoms between visits and keeping patients on schedule for follow-up during maintenance therapy, calling both essential to a functioning multidisciplinary team.

In the next episode, "Extending the Academic NMIBC Care Model to Community Practice," Tyson and Drakaki discuss how the academic coordination model they've described can extend to community practices, including the tools that keep those partnerships running.