Does a community cancer center one-day prostate cancer multidisciplinary clinic result in a change in treatment recommendation?

Abstract

82 Background: Multi-disciplinary clinics (MDCs) offer patients the opportunity to meet with multiple providers to discuss treatment options for recently diagnosed prostate cancer. Multiple academic centers have published their experience with these clinics. However, this approach has been sparsely reported in the community setting. Herein, we assess if an MDC results in more appropriate treatment recommendations for patients based on NCCN risk category compared to incoming (non-MDC) treatment recommendations. Methods: A retrospective chart review of patients evaluated in the institutional prostate cancer MDC clinic were reviewed over a 22 month period (January 2015 through October 2016). A single urologist and radiation oncologist served as clinic consultants for all patients. Patients were asked to report the recommendation for treatment prior to evaluation in the MDC clinic, and the patient selection for treatment after evaluation in the MDC clinic. Changes in treatment recommendation were recorded based on NCCN risk category (low [LR], intermediate [IR], and high [HR] risk groups). Results: Eighty patients were evaluated in the MDC. Of the 80 patients, 64 (80%) chose to continue care with the providers in the prostate MDC. Evaluable records (i.e. initial treatment recommendations) were available for 46 of the 64 patients (72%). Median age of the evaluable patients was 67 years (range 43-83). By risk category, 15 (33%) were LR, 21 (46%) were IR, and 10 (22%) were HR. Eleven patients in the LR group (73%) had altered treatment recommendations, 82% of whom were changed from any treatment (surgery or radiation) to active surveillance. Ten patients in the IR group (48%) and four patients in the HR group (40%) had altered treatment recommendations, mostly from surgery to radiation +/- ADT (50% in the IR, and 75% in the HR group). For all patients seen in the MDC, eight (10%) enrolled on a clinical trial (prostate stereotactic radiation). Conclusions: Implementation of a community-based, one-day prostate MDC resulted in significant changes in treatment recommendations, particularly in increasing active surveillance for LR patients and reducing surgical intervention in IR and HR patients.