Multidisciplinary clinics increase adherence to recommended prostate cancer treatments
The results of a new study suggest that individuals newly diagnosed with prostate cancer are more likely to adhere to nationally recommended treatment regimens and discuss available treatment options with their healthcare providers if they attend multidisciplinary clinics.
The results of the largest and longest analysis of a multidisciplinary clinics’ electronic health records database, led by investigators from The University of Texas MD Anderson Cancer Center (TX, USA), suggest that newly diagnosed prostate cancer patients are more likely to discuss the extent of available treatment options and adhere to national treatment guidelines if they attend multidisciplinary cancer clinics, compared with national trends.
Prostate cancer is the most common non-skin cancer form that affects men; the American Cancer Society (GA, USA) predict that 174,650 new cases of prostate cancer will be diagnosed this year. Although previous research has demonstrated that mortality rates of individuals who opt for active surveillance compared to definitive treatment are similar, many patients experience preventable definitive treatment-related side effects.
Lead study author Chad Tang (The University of Texas MD Anderson Cancer Center) explained: “Men who visit a [multidisciplinary] prostate clinic have the opportunity to see a radiation oncologist and a urologist in the same visit, giving them the chance to discuss treatments options and potential side effects in order to make an informed treatment decision. Patients and their families appreciate the opportunity to hear all treatment options and receive assistance with decision making.”
Frequently asked questions:
In the study, researchers compared the treatment choices of 4451 patients who attended The University of Texas MD Anderson's Multidisciplinary Prostate Cancer Clinic (TX, USA) between 2004 and 2016 with those of 392,710 men with prostate cancer patients from the Surveillance, Epidemiology and End Results (SEER) database – a nationally representative database.
National Comprehensive Cancer Network (NCCN; PA, USA) guidelines recommend that men with high-risk prostate cancer receive aggressive, definitive treatment; all men at the Multidisciplinary Prostate Cancer Clinic with high-risk prostate cancer received such recommended aggressive treatment. By contrast, one-fifth of patients in the SEER database who had high-risk disease opted to receive non-definitive treatment.
Similarly, for men with low-risk disease, NCCN guidelines advise progressing with active surveillance. Amongst men with low-risk prostate cancer, active surveillance rates were 74% and 54% at the multidisciplinary clinic and SEER respectively.
Further, although previous studies have demonstrated an increased use of definitive therapy amongst white patients compared with African American patients, at the multidisciplinary clinic, rates of definitive therapy provision were higher amongst high-, intermediate- and young, low-risk African American patients, compared with white men.
Tang commented: “These results suggest that when offered treatment options by a multidisciplinary team, African American men may choose a more definitive treatment choice. The outcomes of this study offer an important motivation to provide multidisciplinary clinical care on the national level.”
In the study, the authors concluded: “Presentation at a [multidisciplinary] clinic facilitates the appropriate disposition of patients with low‐risk disease to nondefinitive strategies of patients with high‐risk disease to definitive treatment, and it may obviate the influence of race.
Tang C, Hoffman KE, Allen PK et al. Contemporary prostate cancer treatment choices in multidisciplinary clinics referenced to national trends. Cancer. doi:org/10.1002/cncr.32570 (2019) (Epub ahead of print);
Definitive therapy refers to treatment that is intended to treat a cancer. The treatment can be aggressive and multifaceted and is recommended for high-risk cancer patients.
Active surveillance, or active monitoring, allows healthcare professionals to monitor early, localised cancer, rather than treat it immediately, so as to delay or prevent treatment-related side effects. Treatment may be initiated if test results reveal that the cancer may be growing, or the patient decides they want to commence treatment.