Multidisciplinary approach to PCa care draws high-risk patients

Prostate cancer patients tend to opt for a major cancer center if they have severe disease, but stay closer to home for less complicated cases, even when offered a model of care that taps numerous experts, according to a study by researchers from Duke Cancer Institute, Durham, NC.

The authors say the study, published in the Journal of Urology (2012; 187:103-8), is the first large analysis of the so-called multidisciplinary care strategy that gives prostate cancer patients access to a surgeon, a medical oncologist, and a radiation oncologist all in a single visit. The care team then decides as a group what’s best for the patient, easing the bias for any one specialty.

"Optimum management of prostate cancer continues to be controversial and not well defined," said lead author Suzanne B. Stewart, MD. "With so many options, it can leave patients with uncertainty and distress."

The authors studied two groups from 2005 to 2009: one group of 701 patients who sought an evaluation at Duke’s multidisciplinary prostate cancer clinic and 1,318 who accessed care in the hospital’s traditional urology prostate cancer center or genitourinary oncology clinics.

In the multidisciplinary clinic, which is generally offered once per week, the men seeking evaluations tended to be younger, Caucasian, more affluent, and live further away than Duke’s typical prostate cancer patients. Sixty-one percent of the men sought the clinic on their own, rather than through a physician who referred them because they had a difficult case.

But those patients often did not undergo treatment in the clinic. About 42% of the multidisciplinary clinic patients opted for treatment closer to home, especially if they had low-risk disease. As a result, those who actually received multidisciplinary care were sicker, and were demographically similar to typical Duke prostate cancer patients: younger, African-American, lower income, and living nearby.

"From the patient perspective, it’s a wonderful opportunity to get an in-depth education about the disease, but it’s difficult for many health systems to do something like this, considering the time commitment of multiple cancer specialists needed at the same time for the clinic," said senior author Judd W. Moul, MD. "In light of multitude new treatments that have been approved in the last 2 years for advanced prostate cancer, it is critical to embrace the multi-D concept so that patients can become acclimated to the total care team earlier in their disease course."

Go back to this issue of Urology Times eNews.