MULTI-DISCIPLINARY MANAGEMENT OF PROSTATE CANCER PATIENTS AT FONDAZIONE IRCCS ISTITUTO NAZIONALE DEI TUMORI: AN UPDATE

• Published in: Anticancer research Vol. 38; no. 4; p. 2540
• Main Authors: Badenchini, Fabio, Magnani, Tiziana, Alessi, Alessandra, Avuzzi, Barbara, Balzarini, Augusta, Bedini, Nice, Bellardita, Lara, Borreani, Claudia, Carrara, Mauro, Casale, Alessandra, Catanzaro, Mario, Cerrotta, Annamaria, Colecchia, Maurizio, Crippa, Flavio, De Luca, Letizia, Di Florio, Teresa, Donegani, Simona, Dordoni, Paola, Fallai, Carlo, Giandini, Tommaso, Grassi, Paolo, Lanocita, Rodolfo, Maccauro, Marco, Macchi, Alberto, Marenghi, Cristina, Martini, Cinzia, Menichetti, Julia, Messina, Antonella, Morlino, Sara, Chiorda, Barbara Noris, Paolini, Biagio, Pignoli, Emanuele, Procopio, Giuseppe, Ripamonti, Carla, Seregni, Ettore, Spreafico, Carlo, Silvia, Stagni, Tesone, Antonio, Torelli, Tullio, Vaiani, Marta, Verzoni, Elena, Villa, Sergio, Zecca, Ernesto, Salvioni, Roberto, Nicolai, Nicola, Monti, Patrizia, Valdagni, Riccardo
• Format: Journal Article
• Language: English
• Published: Athens International Institute of Anticancer Research 01.04.2018
• Subjects: Cancer; Clinical trials; Collaboration; Consultation; Data processing; Decisions; Division; Medical research; Metastases; Metastasis; Neck; Organizational aspects; Patients; Prostate cancer; Psychologists; Radiation; Scheduling; Tumors; Urology
• ISSN: 0250-7005; 1791-7530

After the launch of the Prostate Cancer Programme in September 2004, the clinical management of prostate cancer (PCa) patients at Fondazione IRCCS Istituto Nazionale dei Tumori (INT), in Milan, became multidisciplinary, and multidisciplinary consultations and clinical case discussions were organized on a weekly routine basis. From the start it was clear that the model needed to be adaptable to meet new clinical and organizational needs. Magnani et al. (1) referred to the 2004-2011 experience. This abstract describes the initial multidisciplinary consultations and the clinical case discussions in terms of numbers, organization and access and the changes introduced in 2012-2017. From March 2005 to October 2017 an average of 350 multidisciplinary consultations per year were performed on a weekly basis. An urologist, a radiation oncologist and a psychologist were seeing 8 patients with a PCa diagnosis in any state of disease who refer to INT for the first time. Medical oncologists are also involved in advanced or metastatic PCa. From March 2005 to October 2017, an average of 340 clinical case discussions per year was performed on a weekly basis. At least one representative for urology, radiation oncology, medical oncology, the research nurse and the project manager participated mandatorily, while other professionals (for example imaging specialists, uropathologists, palliative care specialists) were called in on particular cases. Prostate Cancer Unit (PCU) was formalized in 2009 and updated in 2013. In February 2017 the collaboration between INT PCU and Urology Division at Policlinico, Milan, was made official to implement the PCa path of care of both institutes, also in line with Valdagni’s et al. papers on PCU (2, 3). Magnani et al. reported on INT multidisciplinary activities from March 2005 to March 2011 (1). Since 2012, an increase in very low-/lowrisk class patients (61.5% vs. 51%) and a decrease in highrisk (13% vs. 26%) and metastatic (1.5% vs. 5%) patients were observed, compared to the period 2005-2011. The percentage of intermediate-risk patients was maintained (26% vs. 24%). 9.5% of the patients had already received a PCa treatment before visit. The following changes were introduced in the organizational model: (i) Due to the lack of resources (psychologists are supported by a grant from a private donor) the individual counselling meeting with the psychologist after the first multidisciplinary consultation was interrupted in 2014. Patients who seemed to potentially benefit from psychological support were invited to meet the psychologist in the afternoon or schedule an appointment. (ii) Selection of cases for clinical case discussions: In the 2005-2011 period, all cases examined in the multidisciplinary clinic were discussed in the weekly tumour board to evaluate adherence to guidelines, check on the quality of the decisions formulated in the clinic, to tailor therapeutic or observational strategies and to facilitate the interdisciplinary collaboration and education. After carefully analyzing the data on the clinical case discussions and the changes applied to the decisions taken in the clinic, in 2014 we chose not to discuss all the cases examined in the first multidisciplinary consultations. Since 2014 clinical case discussions were mainly focused on patients who, after the multidisciplinary consultations, had to complete staging before therapeutic and observational options could be proposed and patients on active surveillance or watchful waiting with borderline situations with respect to institutional protocols. (iii) Since 2015 a research nurse has participated in the clinical case discussions, thus enabling the selection of patients to be included in clinical trials. In addition, the nurse became the contact person between clinicians and patients and follows up after the discussion to schedule appointments, to plan future steps and to inform patients and clinicians. (iv) The formalization of the PCU identified and named the specialists involved in the PCa path of care divided in core and non-core team, described the PCa dedicated activities and the participation in the PCU multidisciplinary activities. As regards the clinical case discussions, professionals of the non-core team needed on a particular case were receiving a request from the PCU Secretary and upon their confirmation the case was scheduled. (v) Since the formalization of INT PCUPoliclinico collaboration, urologists from Policlinico participate in the clinical case discussions presenting their cases. Multidisciplinary approach has proven successful to address PCa complexity. A flexible organizational model is necessary to meet new scenarios (both clinical and organizational). Monitoring is mandatory to detect bottle necks and criticisms.