Enhancing prostate cancer care through the multidisciplinary clinic approach: a 15-year experience

Abstract

Purpose: To report on the 15-year prostate cancer experience of our multidisciplinary genitourinary cancer clinic established in 1996 at the National Cancer Institute (NCI) -designated Jefferson Kimmel Cancer Center. Patients with genitourinary cancers were evaluated weekly by multiple specialists at a single site, and we focus on the 83% of patients with prostate cancer. To our knowledge, our multidisciplinary genitourinary cancer clinic is the longest continuously operating center of its kind at an NCI Cancer Center in the United States.

Methods: Data from Jefferson's Oncology Data Services were compared to SEER prostate cancer outcomes. Data on treatment changes in localized disease, patient satisfaction, and related parameters were also assessed.

Results: Ten-year survival data approach 100% in stage I and II prostate cancer. Ten-year data for stage III (T3 N0M0) and stage IV (T4 N0M0) disease show that our institutional survival rate exceeds SEER. There is a shift toward robotically assisted laparoscopic radical prostatectomy and a slight decrease in brachytherapy relative to external beam radiation therapy in localized disease. Patient satisfaction is high as measured by survey instruments.

Conclusion: Our long-term experience suggests a benefit of the multidisciplinary clinic approach to prostate cancer, most pronounced for high-risk, locally advanced disease. A high level of satisfaction with this patient-centered model is seen. The multidisciplinary clinic approach to prostate cancer may enhance outcomes and possibly reduce treatment regret through a coordinated presentation of all therapeutic options. This clinic model serves as an interdisciplinary educational tool for patients, their families, and our trainees and supports clinical trial participation.

Figure 1.

Kaplan-Meier survival of patients with newly diagnosed prostate cancer at the TJUH/KCC (1996-2008) and patients in NCI SEER (1997-2003). (A) Stage III (T3 N0 M0); (B) T4 N0 M0. TJUH, Thomas Jefferson University Hospital; KCC, Kimmel Cancer Center; NCI, National Cancer Institite; SEER, Surveillance, Epidemiology, and End Results.

Figure 2.

Treatment changes over time, in surgical method (A) and radiation treatment type (B). EBRT, external beam radiation therapy.

Figure 3.

(A) Initial 1996 to 2008 clinic process; (B) patient flow through the multidisciplinary genitourinary cancer clinic based on the current model.