Multidisciplinary clinics may improve prostate cancer care
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Men with prostate cancer who sought treatment at a multidisciplinary clinic appeared more likely to receive advice about treatment choices and care supported by evidence-based guidelines, according to study results published in Cancer.
Such care may remove the influence of race on treatment, researchers noted.
“We were interested in querying the results of our multidisciplinary clinic experience, as our clinic has been open for a while,” Chad Tang, MD, researcher in the department of radiation oncology at The University of Texas MD Anderson Cancer Center, told Healio. “We found that when we have a clinic that allows for a condensed visit with multiple practitioners, patient choice closely mirrors that of national guidelines and is irrespective of race.”
Multidisciplinary clinics provide patients with multiple treatment choices presented by specialists in participating disciplines. The University of Texas MD Anderson Cancer Center’s multidisciplinary clinic for prostate cancer allows men with newly diagnosed prostate cancer to discuss treatment options with a urologist and radiation oncologist to facilitate informed decision-making and expedite time to treatment initiation.
Tang and colleagues compared treatment decisions among 4,451 men (median age, 62 years) seen at the MD Anderson multidisciplinary prostate cancer clinic between 2004 and 2016 with nationwide trends. They assessed nationwide trends by analyzing 392,710 men (median age, 65 years) diagnosed with prostate cancer between 2004 and 2015 and included in the SEER database.
Treatment choice as a function of pretreatment demographics served as the study’s primary endpoint.
According to study results, men with low-risk prostate cancer receiving treatment at the multidisciplinary clinic in 2015 were more likely to choose active surveillance compared with men in the SEER database (74% vs. 54%). Moreover, approximately 20% of men with high-risk prostate cancer in the SEER group chose nondefinitive treatment, whereas all men with high-risk disease at the multidisciplinary clinic received definitive treatment.
Among men treated at the multidisciplinary clinic, older age appeared associated with decreased use of brachytherapy (OR = 0.98 per year; P = .02) and prostatectomy (OR = 0.94 per year; P < .001) but increased use of external beam radiotherapy (OR = 1.06 per year; P < .001). For men in the SEER group, older age was also associated with decreased use of brachytherapy (OR = 0.95 per year; P < .001) and prostatectomy (OR = 0.89 per year; P < .001).
Black men receiving treatment at the multidisciplinary clinic who had high-risk and intermediate-risk prostate cancer appeared more likely to receive definitive therapy than their white counterparts. The opposite was true among the SEER group.
“Subsequent research will entail pre- and post-multidisciplinary surveys on patients in the multidisciplinary clinics,” Tang told Healio. “This was published by ASTRO this year, and the manuscript is being written now.”
The data presented by Tang and colleagues serve as a useful benchmark for practice patterns within a world-renowned cancer center, although more data would help to contextualize the findings, Scott E. Eggener, MD, researcher in the section of urology at University of Chicago Medicine, wrote in an accompanying editorial.
“On the basis of many elements of the patient population, particularly their willingness and ability to travel to Houston, as well as unique features of the clinicians, it is unclear whether the findings are generalizable to other settings or practitioners,” Eggener wrote. “I remain uncertain whether this is practical — timewise, geographically, logistically, financially — in most clinical settings.” – by Jennifer Southall
For more information:
Chad Tang, MD, can be reached at The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd., Houston, TX 77030-4004; email: ctang1@mdanderson.org.
Disclosures: The study was supported by grants from the NCI. Tang reports personal fees from RefleXion outside the submitted work and grants from the Anna Fuller Foundation, Cancer Prevention and Research Institute and Radiation Oncology Institute. Please see the study for all other authors’ financial disclosures. Eggener reports no relevant financial disclosures.
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