Enhancing Prostate Cancer Care Through the Multidisciplinary Clinic Approach: A 15-Year Experience

Gomella, Leonard G.; Lin, Jianqing; Hoffman-Censits, Jean H.; Dugan, Patricia; Guiles, Fran; Lallas, Costas D.; Singh, Jaspreet; McCue, Peter A.; Showalter, Timothy N.; Valicenti, Richard K.; Dicker, Adam P.; Trabulsi, Edouard J.

doi:10.1200/jop.2010.000071

Cited by 97 publications

(90 citation statements)

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“…The importance of coordinated multidisciplinary care has been increasingly emphasized for oncology patients with a wide array of cancers including breast, pancreatic, and prostatic [1][2][3][4][5][6][7][8][9] . Weekly tumour boards and single-day multidisciplinary clinics both allow a variety of providers to review and contribute to the care plan of patients with cancer, but these two approaches have some important differences.…”

Section: Discussionmentioning

confidence: 99%

“…Although outcomes of multidisciplinary clinics have been described for several cancer types [1][2][3][4][5][6][7][8][9][12][13][14][15][16][17][18][19][20] , no study to date has documented the outcomes of a single-day liver multidisciplinary clinic. The multidisciplinary liver clinic (mdlc) at the Johns Hopkins Hospital (jhh) was established in 2009 so that patients with liver tumours could be evaluated by a range of specialists within the same visit day and site.…”

Section: E124mentioning

confidence: 99%

“…Multidisciplinary clinics can, however, be more resource-intense and might require providers to deviate from their normal clinic routine. Multidisciplinary cancer clinics have been adopted for patients with breast 1-3 , gynecologic [12][13][14] , pancreatic 4,5 , lung 13,15 , skin [16][17][18] , head-and-neck 19,20 , and prostate malignancies [6][7][8][9] . Multidisciplinary clinics have even been proposed for patients with specific types of metastases 21 .…”

Section: E124mentioning

confidence: 99%

“…In most hospitals, multidisciplinary care consists of separate clinic visits with various specialists in conjunction with a weekly tumour board discussion. One reason for the emphasis on this approach is the accumulating evidence that multidisciplinary care leads to more favourable patient outcomes [1][2][3][4][5][6][7][8][9] . In this regard, contemporary recommendations support the management of oncologic patients by a multidisciplinary team including surgical oncologists, medical oncologists,…”

Section: Introductionmentioning

confidence: 99%

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Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

et al. 2013

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51%) returned for a follow-up, and 154 of the returnees (89%) received treatment, primarily intraarterial therapy (n = 88, 57%), systemic chemotherapy (n = 60, 39%), or liver resection (n = 32, 21%). Enrollment in a clinical trial was proposed to 34 patients (10%), and 21 of the 34 (62%) were accrued. ConclusionsPatient assessment by our multidisciplinary liver clinic had a significant impact on management, resulting in alterations to imaging and pathology interpretation, diagnosis, and management plan. The mdlc is an effective and convenient means of delivering expert opinion about the diagnosis and management of liver tumours.

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Section: Discussionmentioning

confidence: 99%

Section: E124mentioning

confidence: 99%

Section: E124mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

et al. 2013

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“…In addition, many studies suggest that the morbidity associated with radical prostatectomy (specifically the robotic approach) is similar between high risk and lower risk disease [4] and therefore surgery is more tolerable than a decade ago. One well established MDC clinic reported improved survival in high stage patients (stage III,IV) treated at their MDC when compared to the SEER national database [5].…”

Section: Short Communicationmentioning

confidence: 99%

Communication on the Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease

Leone¹,

Diorio²,

Mega³

et al. 2016

J Med Surg Pathol

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The authors of this manuscript present the effect of successful implementation of a multidisciplinary genitourinary oncology clinic (MDC). The clinic includes coordinated patient visits with medical oncology, urologic oncology, and radiation oncology. At The Miriam Hospital MDC in Providence, Rhode Island (major affiliate of Brown University), individual patients meet with members of the medical oncology, radiation oncology, and urologic oncology teams to discuss their diagnosis, prognosis and potential treatment options [1]. Each specialty has the ability to put forth treatment recommendations based on the patient's comorbidities, clinical stage and appropriate risk stratification (NCCN).The widespread adoption of robotic prostatectomy and the capital investment in robotic systems nationwide has led many to anticipate more surgery for low risk prostate cancer. However, at roughly the same time the USPSTF recommendations for reduction in prostate cancer screening and the adoption of active surveillance for very low and low risk prostate cancer surfaced.Contrary to what was expected, we found that our patients, seen at the MDC, undergoing surgery were more likely to have higher risk and stage prostate cancer and that overtreatment of potentially indolent prostate cancer was not seen. With the aggressive adoption of active surveillance surgery for Gleason 3+3 diseases dropped to less than 10% (Unpublished Data The Miriam Hospital MDC 2015).Finally, it is difficult to determine causation from association and the specific effect of a MDC on pathological upstaging. The implementation of a MDC at other institutions has been associated with changes in disease risk classification. Sundi et al. found patients were up-classified 5.7% of the time and were down-classified 2.9% of the time as a result of a MDC appointment [2]. While much emphasis has been placed on treatment modalities that are selected after patients are seen in a MDC, it is clear that the proper assignment of risk stratification is essential to optimizing care.

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Androgen Deprivation Therapy and Competing Risks

Kelly¹,

Gomella²

2011

JAMA

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A NDROGEN DEPRIVATION THERAPY (ADT) HAS BEEN the mainstay for the treatment of advanced prostate cancer for the past 7 decades. Surgical castration (orchiectomy) and the use of estrogens have been largely replaced by the administration of gonadotropin-releasing hormone (GnRH) agonists as the most common form of ADT used today.1,2 GnRH agonists are relatively easy to administer, avoid the well-known cardiovascular risks of estrogens and the psychological trauma of surgical castration, and allow the potential for the androgen blockade to be reversed. 1,2 In the armamentarium of drugs used to treat cancer, modern ADT is generally considered to be well tolerated; however, adverse effects of ADT can include loss of libido, hot flashes, weight gain, osteopenia, unique metabolic syndrome, and alterations in lipid profile. [1][2][3] More recent data suggest there may be an association between ADT with GnRH agonists and increased incidence of cardiovascular disease and cardiovascular mortality. This concern was first recognized from 2 population-based studies using the data from the national Surveillance, Epidemiology, and End ResultsMedicare database. A study by Keating et al 4 reported an association between ADT and increased risk of incident of coronary heart disease (adjusted hazard ratio [HR], 1.16; 95% CI, 1.10-1.21), myocardial infarction (adjusted HR, 1.11; 95% CI, 1.05-1.27), and sudden cardiac death (adjusted HR, 1.16; 95% CI, 1.05-1.27). A study by Saigal et al 5 noted that ADT was associated with an increased risk of serious cardiovascular morbidity (HR, 1.20; 95% CI, 1.15-1.26) during 5 years of follow-up of patients treated with ADT. Data from the Prostate Strategic Urologic Research Endeavor (CaP-SURE) database further confirmed the increased risk of cardiovascular disease among patients with localized prostate cancer treated with ADT. 6 These reports in combination with other studies showing an association between ADT and cardiovascular risk prompted the US Food and Drug Administration to issue a safety warning on October 20, 2010, requiring labeling on GnRH agonists about an "increased risk of diabetes and certain cardiovascular diseases (heart attack, sudden cardiac death, stroke) in men receiving these medications for the treatment of prostate cancer."7 The cumulative data to date support the warning issued by the Food and Drug Administration; however, these data leave practicing physicians and patients in a quandary when the risks of a GnRH agonist outweigh its benefits.The study in this issue of JAMA by Nguyen and colleagues 8 helps further clarify this dilemma. The authors report the results of a systematic review and meta-analysis of randomized trials to determine whether ADT is associated with cardiovascular mortality, prostate cancer-specific mortality, and all-cause mortality in men with unfavorable-risk, nonmetastatic prostate cancer. In 8 randomized trials that consisted of 4141 patients, the incidence of cardiovascular death among patients receiving ADT vs control was 11.0% (95% CI, 8.3%-...

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Enhancing Prostate Cancer Care Through the Multidisciplinary Clinic Approach: A 15-Year Experience

Cited by 97 publications

References 11 publications

Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

Impact of a Single-Day Multidisciplinary Clinic on the Management of Patients with Liver Tumours

Communication on the Impact of Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease

Androgen Deprivation Therapy and Competing Risks

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