15 years of experience from a multidisciplinary prostate cancer clinic

The November issue of the Journal of Oncology Practice is significantly focused on experience to date from multidisciplinary cancer clinics, where patients are seen by a variety of relevant specialists during a single visit to the clinic.

The multidisciplinary prostate cancer clinic at the Thomas Jefferson University Kimmel Cancer Center (KCC) in Philadelphia is believed to be the longest continuously operating multidisciplinary clinic of its kind at an NCI Cancer Center in the United States. In this issue of the Journal of Oncology Practice, Gomella et al. describe their experience over the past 15 years and offer strong encouragement to other multidisciplinary clinics to report data based on their experience too.

They provide data from their clinic as compared to data from the Surveillance, Epidemiology, and End Results (SEER) database and the National Cancer Database (NCD)

The core data reported by Gomella et al. are as follows:

  • Overall patient distribution was generally similar by disease stage across the KCC, SEER, and NCD databases.
  • A slightly higher proportion of the KCC cohort had intermediate-stage (AJCC stages II/III) disease:
    • KCC cohort — 90.8 percent
    • SEER database — 87.7 percent
    • NCD cohort — 84.2 percent
  • 5- and 10-year outcome data are currently available through December 2006.
  • 10-year overall survival for patients in the KCC cohort initially diagnosed with AJCC stage I and stage II prostate cancer approaches 100 percent (comparable to the SEER data and reports from other centers).
  • The probability of overall survival at 5 years for patients in the KCC cohort initially diagnosed with AJCC stage III (T3N0M0) disease was 0.90, which exceeds the probability of overall survival at 5 years for similar patients in the SEER cohort (0.78).
  • The probability of overall survival at 5 years  for patients in the KCC cohort initially diagnosed with AJCC stage IV (T4N0M0) disease was 0.70, which exceeds the probability of overall survival at 5 years for similar patients in the SEER cohort (0.50).
  • The median age of patients initially diagnosed with AJCC stage III and stage IV disease in the KCC cohort was younger (at 62 years) than those in the SEER database (at 73 years); however, the survival advantage described above was retained after adjustment for age.
  • Based on data from a six-point questionnaire, more than 90 percent of patients reported that their experience with the multidisciplinary program was “good” or “very good” and would recommend it.

This study is also discussed in greater detail in a recent commentary on the Medscape Oncology web site. You can find full patient satisfaction data in the Medscape Oncology report as well as some interesting observations from Dr. Charles Drake, who is a co-director of the multidisciplinary prostate clinic at Johns Hopkins (which started some time after the KCC program). There seems to be a consensus that patients seen at multidisciplinary prostate cancer clinics at major academic medical centers will, indeed, tend to have high quality outcomes over time. However, whether such outcomes will be significantly better than the national standard of care remains to be established. Even though it is more difficult to establish multidisciplinary prostate cancer clinics in community settings, we are starting to see this type of initiative in some community-based programs.

Another point worth noting from this issue of the Journal of Oncology Practice comes from a paper by Bunnell et al. This paper is not exclusively focused on prostate cancer multidisciplinary clinics, so its findings should be treated with caution with regard to prostate cancer specifically.

What Bunnell et al. point out is that there are basically two types of multidisciplinary clinic. In the first, specialists of all types meet with individual patients as a group. In other words, a prostate cancer patient could expect to meet with a surgeon, a radiation oncologist, and a medical oncologist all together as a collaborative team. (This is the methodology used by the KCC multidisciplinary prostate cancer center described above.) Under the second scenario, the patient meets sequentially with each specialist. Bunnell et al. found that about a third of the physicians working in multidisciplinary clinics had significant reservations about their efficiency — and particularly the team type — because they took up more clinical time. However, 90 percent of the physicians believed that patients perceived the clinics to be valuable for comprehensive, coordinated, and appropriate care. In addition, more than 90 percent of the physicians enjoyed the experience of working in a multidisciplinary clinic.

2 Responses

  1. This sounds like a great idea, if only because it is so fair to the patient. If they get better outcomes, though, it might be because folks good enough to have such an approach are also good at what they do by way of treatment.

  2. Where are the QoL results? That’s where the “rubber hits the road.”

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