Lauren C Harshman1, Abhishek Tripathi2, Matthew Kaag3, Jason A Efstathiou4, Andrea B Apolo5, Jean H Hoffman-Censits6, Walter M Stadler7, Evan Y Yu8, Bernard H Bochner9, Eila C Skinner10, Tracy Downs11, Anne E Kiltie12, Dean F Bajorin9, Khurshid Guru13, William U Shipley4, Gary D Steinberg7, Noah M Hahn14, Srikala S Sridhar15. 1. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. Electronic address: LaurenC_Harshman@dfci.harvard.edu. 2. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. 3. Penn State Milton S. Hershey Medical Center, Hershey, PA. 4. Massachusetts General Hospital, Harvard Medical School, Boston, MA. 5. National Cancer Institute, National Institutes of Health, Bethesda, MD. 6. Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA. 7. The University of Chicago, Chicago, IL. 8. Fred Hutchinson Cancer Research Center, Seattle, WA. 9. Memorial Sloan Kettering Cancer Center, New York, NY. 10. Stanford University School of Medicine, Stanford, CA. 11. University of Wisconsin, Madison, WI. 12. Cancer Research UK/Medical Research Council, Oxford Institute for Radiation Oncology, Oxford, United Kingdom. 13. Roswell Park Cancer Institute, Buffalo, NY. 14. Johns Hopkins University School of Medicine, Baltimore, MD. 15. Princess Margaret Cancer Centre, Toronto, ON, Canada.
Abstract
BACKGROUND: Multidisciplinary clinics integrate the expertise of several specialties to provide effective treatment to patients. This exposure is especially relevant in the management of muscle-invasive bladder cancer (MIBC), which requires critical input from urology, radiation oncology, and medical oncology, among other supportive specialties. MATERIALS AND METHODS: In the present study, we sought to catalog the different styles of multidisciplinary care models used in the management of MIBC and to identify barriers to their implementation. We surveyed providers from academic and community practices regarding their currently implemented multidisciplinary care models, available resources, and perceived barriers using the Bladder Cancer Advocacy Network and the Genitourinary Medical Oncologists of Canada e-mail databases. RESULTS: Of the 101 responding providers, most practiced at academic institutions in the United States (61%) or Canada (29%), and only 7% were from community practices. The most frequently used model was sequential visits on different days (57%), followed by sequential same-day (39%) and concurrent (1 visit with all providers; 22%) models. However, most practitioners preferred a multidisciplinary clinic involving sequential same-day (41%) or concurrent (26%) visits. The lack of clinic space (58%), funding (41%), staff (40%), and time (32%) were the most common barriers to implementing a multidisciplinary clinic. CONCLUSION: Most surveyed practitioners at academic centers use some form of a multidisciplinary care model for patients with MIBC. The major barriers to more integrated multidisciplinary clinics were limited time and resources rather than a lack of provider enthusiasm. Future studies should incorporate patient preferences, further evaluate practice patterns in community settings, and assess their effects on patient outcomes.
BACKGROUND: Multidisciplinary clinics integrate the expertise of several specialties to provide effective treatment to patients. This exposure is especially relevant in the management of muscle-invasive bladder cancer (MIBC), which requires critical input from urology, radiation oncology, and medical oncology, among other supportive specialties. MATERIALS AND METHODS: In the present study, we sought to catalog the different styles of multidisciplinary care models used in the management of MIBC and to identify barriers to their implementation. We surveyed providers from academic and community practices regarding their currently implemented multidisciplinary care models, available resources, and perceived barriers using the Bladder Cancer Advocacy Network and the Genitourinary Medical Oncologists of Canada e-mail databases. RESULTS: Of the 101 responding providers, most practiced at academic institutions in the United States (61%) or Canada (29%), and only 7% were from community practices. The most frequently used model was sequential visits on different days (57%), followed by sequential same-day (39%) and concurrent (1 visit with all providers; 22%) models. However, most practitioners preferred a multidisciplinary clinic involving sequential same-day (41%) or concurrent (26%) visits. The lack of clinic space (58%), funding (41%), staff (40%), and time (32%) were the most common barriers to implementing a multidisciplinary clinic. CONCLUSION: Most surveyed practitioners at academic centers use some form of a multidisciplinary care model for patients with MIBC. The major barriers to more integrated multidisciplinary clinics were limited time and resources rather than a lack of provider enthusiasm. Future studies should incorporate patient preferences, further evaluate practice patterns in community settings, and assess their effects on patient outcomes.
Authors: J P Stein; G Lieskovsky; R Cote; S Groshen; A C Feng; S Boyd; E Skinner; B Bochner; D Thangathurai; M Mikhail; D Raghavan; D G Skinner Journal: J Clin Oncol Date: 2001-02-01 Impact factor: 44.544
Authors: Jason A Efstathiou; Daphna Y Spiegel; William U Shipley; Niall M Heney; Donald S Kaufman; Andrzej Niemierko; John J Coen; Rafi Y Skowronski; Jonathan J Paly; Francis J McGovern; Anthony L Zietman Journal: Eur Urol Date: 2011-11-12 Impact factor: 20.096
Authors: Leonard G Gomella; Jianqing Lin; Jean Hoffman-Censits; Patricia Dugan; Fran Guiles; Costas D Lallas; Jaspreet Singh; Peter McCue; Timothy Showalter; Richard K Valicenti; Adam Dicker; Edouard J Trabulsi Journal: J Oncol Pract Date: 2010-11 Impact factor: 3.840
Authors: Brendan J W Miles; Adrian S Fairey; Michael Eliasziw; Eric P Estey; Peter Venner; Daygen Finch; Kiril Trpkov; Bernhard J Eigl Journal: Can Urol Assoc J Date: 2010-08 Impact factor: 1.862
Authors: Raj Kurpad; William Kim; W Kim Rathmell; Paul Godley; Young Whang; Julia Fielding; LuAnn Smith; Ava Pettiford; Heather Schultz; Matthew Nielsen; Eric M Wallen; Raj S Pruthi Journal: Urol Oncol Date: 2009-07-03 Impact factor: 3.498
Authors: H Barton Grossman; Ronald B Natale; Catherine M Tangen; V O Speights; Nicholas J Vogelzang; Donald L Trump; Ralph W deVere White; Michael F Sarosdy; David P Wood; Derek Raghavan; E David Crawford Journal: N Engl J Med Date: 2003-08-28 Impact factor: 91.245
Authors: Timothy M Pawlik; Daniel Laheru; Ralph H Hruban; Joann Coleman; Christopher L Wolfgang; Kurt Campbell; Syed Ali; Elliot K Fishman; Richard D Schulick; Joseph M Herman Journal: Ann Surg Oncol Date: 2008-05-07 Impact factor: 5.344