Prostate Cancer Patients Managed by a Multidisciplinary, Multiprofessional Team: Is It Really Feasible and Effective?
Published on Sep 1, 2012in Annals of Oncology18.274
· DOI :10.1016/S0923-7534(20)33521-3
ABSTRACT The aim of this abstract is to describe the multidisciplinary, multiprofessional management of prostate cancer (PC) patients activated by the Prostate Cancer Programme at Istituto Nazionale dei Tumori, Milan. PC patients should be better managed in a multidisciplinary (MD) setting since they have multiple therapeutic and observational options, depending on the risk class. The PC Programme was established in 2004 as a translational project. A MD team with urologists, radiation oncologists, medical oncologists, psychologists, palliative care experts, uropathologists and radiologists was built, diagnostic and therapeutic guidelines were shared and adopted, a MD clinic was started in March 2005 organized in: Friday clinic: urologist, radiation oncologist and psychologist (medical oncologist on demand) examine PC patients synchronously Monday case discussion (CC) to share the cases, check quality and application of guidelines, discuss problematic cases on observation and complex cases seen monodisciplinarily The MD team became multiprofessional by including a project manager, a secretary, a data manager and a nurse. Results 2760 MD clinics from March 2005 to March 2012. The organizational model was modified to better the service. Considering the % of low risk PC patients referring to the MD clinic (61% in 2009) and on active surveillance protocols (342 patients in Feb 2012), we increased resources to better manage this sub-population. The % of advanced and metastatic PC patients (5% in 2011) induced to organize the lists according to the risk class (medical oncologist on demand). Efficacy of the MD clinic is demonstrated in the drug therapies prescribed outside our Institution and terminated by the MD team (11%). Efficacy of the CC is demonstrated in the % of indications formulated in the MD clinics, changed in the following CC (6%) resulting from quality checks of our own performance. Conclusions The MD approach is proving successful. Strategies are agreed on, cases managed multidisciplinarily, critical issues shared. Psychologists help evaluate education-related and cultural factors in patients' decisions. The CC discussion is fundamental to learn the MD working, create a shared know how and approach the patient as a subject of care rather than disease to cure. Thanks to Pro ADAMO and Fond. Monzino for the support Disclosure All authors have declared no conflicts of interest.