title: The 6-year attendance of a multidisciplinary prostate cancer clinic in Italy: incidence of management changes.
abstract: Study Type - Therapy (decision analysis) Level of Evidence 2b. What's known on the subject? and What does the study add? The benefits of the multidisciplinary approach in oncology are widely recognised. In particular, managing patients with prostate cancer within a multidisciplinarity and multiprofessional context is of paramount importance, to address the complexity of a disease where patients may be offered multiple therapeutic and observational options handled by different specialists and having severe therapy-induced side-effects. The present study describes the establishing of a multidisciplinary clinic at the Prostate Cancer Programme of Milan Istituto Nazionale dei Tumori, its effects on the quality of care provided, and strategies implemented to meet upcoming needs and improve quality standards. Having analysed the data of the 2260 multidisciplinary clinics held from March 2005 to March 2011, our dynamic and modifiable organisational model was evaluated for ways to optimise the human resources, offer high-quality standards, meet new needs and ultimately reduce costs. The study is focused on the organisational aspects and adds a perspective from one of the major oncological centres of reference in Italy and in Europe.
  
  
  OBJECTIVE
  To describe the establishing of a multidisciplinary clinic for men with prostate cancer at the Istituto Nazionale Tumori, Milan. • To evaluate the quality of care provided and to describe the management changes implemented to improve standards and meet new needs.
  
  
  METHODS
  In March 2005, we established a multidisciplinary clinic comprising weekly clinics and case-discussion sessions. • We have altered the organisational model periodically to meet new needs and improve quality.
  
  
  RESULTS
  We held 2260 multidisciplinary clinics up to March 2011. • For stage distribution, patients with low-risk prostate cancer increased to a peak of 61% in 2009, probably because of the anticipation of diagnosis and the active surveillance expertise of the Prostate Cancer Programme at Istituto Nazionale Tumori, Milan. The slight decrease in 2010 might be due to the availability of robot-assisted prostatectomy in several hospitals in Milan, and the start of a multicentre active surveillance protocol in December 2009. • In terms of the efficacy of our multidisciplinary strategy, 11% of drug therapies (mostly hormones) prescribed outside our institute were terminated in the multidisciplinary clinic, and 6% of indications formulated in the multidisciplinary clinics were altered during the case-discussion sessions.
  
  
  CONCLUSIONS
  The multidisciplinary approach needs to be adaptable to meet new needs and improve quality. • Our experience has proved successful for both physicians and patients. The team agrees on strategies; complex cases are managed by a multidisciplinary team; dedicated psychologists contribute their knowledge and perspectives; and patients report the feeling of being cared for.
authors.affiliation: Prostate Cancer Programme, Scientific Director's Office Division of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Tiziana.magnani@istitutotumori.mi.it
authors.forename: Tiziana
authors.initials: T
authors.lastname: Magnani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Valdagni
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvioni
authors.forename: Sergio
authors.initials: S
authors.lastname: Villa
authors.forename: Lara
authors.initials: L
authors.lastname: Bellardita
authors.forename: Simona
authors.initials: S
authors.lastname: Donegani
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Procopio
authors.forename: Nice
authors.initials: N
authors.lastname: Bedini
authors.forename: Tiziana
authors.initials: T
authors.lastname: Rancati
authors.forename: Nadia
authors.initials: N
authors.lastname: Zaffaroni
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D006801:Humans; D007558:Italy; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration / Q000592:standards / Q000639:trends; D011471:Prostatic Neoplasms / Q000628:therapy*; D011787:Quality of Health Care