Integrating Care for Prostate Patients: Multidisciplinary Model Pioneered

Beth Fand Incollingo @fandincollingo
Published: Tuesday, Mar 12, 2013
Gomella and Trabulsi

Leonard G. Gomella, MD, professor and chair of the Department of Urology at Thomas Jefferson University, consults with Edouard J. Trabulsi, MD, far right, an associate professor and specialist in urologic oncology.

For patients diagnosed with localized prostate cancer, the good news is that a variety of treatment options are available. Yet that benefit can also be a stumbling block. To learn about potential therapies, men often must visit a series of doctors with different specialties, sometimes hearing divergent opinions about their care. Then, it’s up to the patients to weigh all the information as they choose a treatment that will forever affect their quality of life.

Leonard G. Gomella, MD, professor and chair of the Department of Urology at Thomas Jefferson University Hospital (TJU) in Philadelphia, noticed that pattern in the mid-1990s, and it occurred to him that there was a better way to handle such cases.

“Sometimes patients would see the surgeon on a Monday, the radiation oncologist on a Wednesday, and the medical oncologist on a Friday,” he said. “We thought that coordinating the care of these men might be something good to try.”

So Gomella and Richard K. Valicenti, MD, MA, then director of the Radiation Oncology Department’s genitourinary (GU) program, spent a year pilot-testing a multidisciplinary clinic for patients with prostate and other genitourinary cancers.

“Our model was that we were all in the same place at the same time evaluating the patients, discussing the patients, and sharing information,” Gomella said. As a result, he said, clinic doctors were able to collaborate to give each patient a definitive treatment recommendation in a single visit.

Seventeen years later, the clinic remains an important part of the way the hospital treats patients with GU cancers, and has served as a model for other departments there interested in providing multidisciplinary care.

Particularly in prostate cancer, for which new treatments are continually being developed, Gomella believes the multidisciplinary approach has become more important than ever.

Multidisciplinary Clinic Workflow

Telephone nursing interview
• Data requested
• MDs identified
• Info package   mailed
• Visit scheduled
• Slides requested
Pathology review of submitted slides with report generated before visit
•Preclinic group meeting
with presentation
•Pathology slide review
•Protocol and treatment
options reviewed
• Individual social work meeting
• Review of other ancillary services (integrative medicine, etc)
• Physician evaluation based on nature of problem
• Imaging review
Clinical trials eligibility assessment
Urologic Surgical Oncology
Radiation Oncology
Medical Oncology
Real-time case discussion
Complex/ rare case tumor board review
Referral letter to physician
Treatment plan and/or additional evaluation
Follow-up call to patient 2-3 days after visit
Treatment scheduled at Kimmel Cancer Center
Adapted from Gomella LG, Lin J, Hoffman-Censits J, et al. Enhancing prostate cancer care through the multidisciplinary clinic approach: a 15-year experience. J Oncol Pract. 2010;6(6):5-10.

Results From the Clinic’s First Decade

Launched in 1996, the GU clinic has been operating longer than any other clinic of its kind at a National Cancer Institute (NCI)-designated cancer center in the United States, according to leaders at the Kimmel Cancer Center at TJU. They shared the wisdom of their experience in a 2010 paper about outcomes for patients with prostate cancer (J Oncol Pract. 2010;6(6):e5-e10).

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