Patients with prostate cancer (PCa) are more likely to receive appropriate care in a multidisciplinary (MultiD) PCa clinic where multiple specialists evaluate and advise patients, according to a new study.
A MultiD clinic provides men with PCa with an opportunity to consult with a radiation oncologist, a urologist, and a medical oncologist as necessary during the same visit to discuss treatment options and potential side effects. MultiD clinic visits facilitate adherence to evidence-based national guidelines and may help eliminate some biases, study findings suggest.
“Despite previous studies on disparities in treatment for African-American men, in the MultiD clinic definitive therapy was appropriately delivered and active surveillance in elderly African Americans was accepted,” study investigator Deborah A. Kuban, MD, of The University of Texas MD Anderson Cancer Center in Houston, told Renal & Urology News. “While many of us who practice MultiD care always thought the above to be true, this study lends evidence to the principle.”
In the largest study of its kind, Dr Kuban and her colleagues compared 4,451 men with PCa receiving care at a MultiD clinic from 2004 to 2016 with 392,710 men in the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with PCa from 2004 to 2015. The median ages were similar in the 2 cohorts; however, the SEER cohort was slightly older than the MultiD cohort (65 vs 62 years).
Previous studies have shown that physicians tend to recommend the treatment that they can deliver, but patients may prefer other options, Dr Kuban said. Since multiple PCa treatment options with similar outcomes are available, patients should be informed of the pros and cons of each treatment and be involved in the decision-making. “This is best done by the associated specialists in order to present the least biased overall opinion,” she said.
The study, which was published in Cancer, showed that African-American men who visited the MultiD clinic were more likely to receive definitive therapy compared with national trends. Overall, men with low-risk disease were more likely to choose active surveillance (AS) in the MultiD clinic compared with the SEER cohort. In 2015, the rate of AS among men with low-risk disease was 74% in the MultiD clinic patients compared with 54% in the SEER group. The tendency toward AS for patients with low-risk PCa is supported by current National Comprehensive Cancer Network (NCCN) guidelines and national trends.
Among high-risk men, significantly more men were offered aggressive treatment in the MultiD clinic group compared with the SEER cohort. All men with high-risk disease received definitive treatment in the MultiD clinic group. However, approximately 20% of men with high-risk disease opted for non-definitive treatment in the SEER group. NCCN guidelines recommend men with high-risk PCa receive definitive treatment.
Among men in the MultiD clinic, black men had significant 17%, 41%, and 52% increased odds of receiving brachytherapy, external beam radiotherapy, and radical prostatectomy, respectively, compared with white men, the investigators reported. Black race in the SEER cohort was associated with an increased use of brachytherapy/brachytherapy boost and EBRT, but the magnitude of this association was less pronounced.
Anthony D’Amico, MD, PhD, Chief of Genitourinary Radiation Oncology at the Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston, said these findings are important because they show how personalized medicine for PCa is evolving. “Multidisciplinary clinics not only bring together expertise from all the specialists involved in the care of prostate cancer permitting a discussion of all appropriate options, but also often provide the opportunity for both pathology and radiology review. All this contributes to optimizing the personalization of the treatment approach, which should lead to better cancer control outcomes,” Dr D’Amico said.
Judd W. Moul, MD, Professor of Surgery and the Director of the Duke Prostate Center at Duke University Medical Center in Durham, North Carolina, said the investigation by Dr Kuban and her collaborators is an excellent study and clinically relevant. “This new paper from MD Anderson is the largest publication to date on the topic. I am a big fan of MultiD,” Dr Moul said. “We do a true MultiD clinic every Friday at Duke and have been doing it since 2004 and patients love being able to see a urologist and medical oncologist and radiation oncologist at same time.”
Amar U. Kishan, MD, Chief of Genitourinary Radiation Oncology at the University of California, Los Angeles, California, said he agrees that these clinics are important in guiding appropriate treatment recommendations. “The authors report several key findings, including that men with low-risk disease who were seen in the multi-disciplinary clinic were significantly more likely to receive non-definitive therapy when compared with men from a large population registry, and, moreover, the trend to offer non-definitive therapy among low-risk patients was more marked over time and began to accelerate earlier in men seen at the multi-disciplinary clinic,” Dr Kishan said.
Dr Kishan added that the new findings should be interpreted with some caveats. “The analysis has several limitations, which the authors acknowledged, including the lack of detailed information about the general health status of the men in the population registry as well as the fact that men seen in the multi-disciplinary status may have significantly greater resources to pursue treatment than men in the population registry,” Dr Kishan said.
Any intervention that helps increase the delivery of guideline-concordant care will help improve overall outcomes for men with PCa, including not only cancer control outcomes, but quality of life outcomes, he added. The MultiD approach also may help mitigate racial disparities that are related to non-standard treatment recommendations. “These findings are important, and hopefully can help encourage the development of more multi-disciplinary clinics across the country,” he said.
Tang C, Hoffman KE, Allen PK, et al. Contemporary prostate cancer treatment choices in multidisciplinary clinics referenced to national trends [published online November 19, 2019]. Cancer. https://doi.org/10.1002/cncr.32570