Impact of a prostate multidisciplinary clinic program on patient treatment decisions and on adherence to NCCN guidelines: the William Beaumont Hospital experience.
OBJECTIVE
In order to demonstrate the impact of multidisciplinary care in the community oncology setting, we evaluated treatment decisions after the initiation of a dedicated prostate and genitourinary (GU) multidisciplinary clinic (MDC).


METHODS
In March 2010, a GU MDC was created at William Beaumont Hospital with the goal of providing patients with a comprehensive multidisciplinary evaluation and consensus treatment recommendations in a single visit. Urologists, radiation, and medical oncologists along with ancillary support staff participated in this comprehensive initial evaluation. The impact of this experience on patient treatment decisions was analyzed.


RESULTS
During the first year, a total of 182 patients were seen. Compared with previous years, low-risk MDC patients more frequently chose external beam radiation therapy (41.1% vs. 26.6%, P=0.02), and active surveillance (14.3% vs. 6.1%, P=0.02) and less frequently prostatectomy (30.4% vs. 44.0%, P=0.03). Similar increases in external beam were seen in intermediate and high-risk patients. Increased use of hormonal therapy was found in high-risk patients compared with the years before the initiation of the MDC (76.2% vs. 51.1%, P=0.03). Increased adherence to National Comprehensive Cancer Network (NCCN) guidelines was seen with intermediate-risk patients (89.8% vs. 75.9%, P=0.01), whereas nonsignificant increases were seen in low-risk (100% vs. 98.9%, P=0.43) and high-risk patients (100% vs. 94.2%, P=0.26).


CONCLUSIONS
The establishment of a GU MDC improved the quality of care for cancer patients as demonstrated by improved adherence to National Comprehensive Cancer Network guidelines, and a broadening of treatment choices made available.
Department of Urology, Beaumont Cancer Institute, Royal Oak, MI 48072, USA.
Howard
H
Korman
Thomas
T
Lanni
Chirag
C
Shah
Jan
J
Parslow
Joyce
J
Tull
Mihai
M
Ghilezan
Daniel
D
Krauss
Savitha
S
Balaraman
Kenneth
K
Kernen
Matthew
M
Cotant
Jeffrey
J
Margolis
Frank A
FA
Vicini
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D003657:Decision Making; D003695:Delivery of Health Care / Q000379:methods*; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000628:therapy*