Multidisciplinary approach benefits urologic cancer patients

A team-based treatment approach to managing prostate and other urologic cancers appears to provide a number of significant benefits, including improved survival, according to the results of two recent studies.

In one study, a research team from the Kimmel Cancer Center (KCC) at Thomas Jefferson University, Philadelphia, concluded that a multidisciplinary clinic approach to aggressive prostate cancer can improve patient survival, as reported online in the Journal of Oncology Practice (November 2010).

Since 1996, the KCC has offered newly diagnosed prostate cancer patients and those needing additional consultation the opportunity to be evaluated in a Multidisciplinary Genitourinary Cancer Clinic (MDGUCC). The clinic team works with patients and referring physicians to devise treatment plans that are tailored to the individual needs of each patient.

"The primary goal of the MDGUCC approach to prostate cancer is to provide this balanced information in an open and interactive fashion, with all clinical specialists present at the same time," said lead author Leonard Gomella, MD. "Shared decision making through a real-time, on site discussion with different specialists about the risks and benefits of each treatment can decrease distress and post-treatment regret."

Researchers compared data from Jefferson’s Oncology Data Services with the Surveillance, Epidemiology and End Results (SEER) program for 2006 (10 years after the MDGUCC clinic started). Data on treatment changes in localized disease and related parameters were also assessed, and patient satisfaction was analyzed from a six-item questionnaire.

Ten-year data for men with aggressive, locally advanced stage III and IV prostate cancer showed that KCC survival rates dramatically exceed SEER’s nationwide survival for locally aggressive prostate cancer, the researchers reported. Ninety percent of patients reported the experience as "good" or "very good" and would recommend the MDGUCC.

In a related study, researchers from the University of North Carolina, Chapel Hill, found a team treatment approach to urologic cancer diagnosis and planning benefits patients by providing more precise diagnosis and staging as well as more comprehensive treatment recommendations. The multidisciplinary approach changed the initial diagnosis or treatment recommendations in almost 65% of cases.

The team reviewed the cases of 269 patients with a diagnosis of urologic cancer who came to the University of North Carolina’s multidisciplinary genitourinary oncology program for a second opinion or treatment. Each patient was seen by one or more health care providers in the areas of urology, surgery, radiation oncology, or medical oncology, with additional consultation by radiation and pathology.

"This study provides evidence to support what we have all felt is true based on our experience-that bringing the brightest minds from a variety of specialties allows us to derive the best treatment plan that is most effective and appropriate for each individual patient," said lead author Raj Pruthi, MD.

The team found that a change in diagnosis or cancer staging was most common in cases of bladder or kidney cancer. Treatment plan changes were most common in bladder, kidney, testicular, and prostate cancer.

The study was published online in Urologic Oncology (July 2, 2009).