title: Multidisciplinary care and pursuit of active surveillance in low-risk prostate cancer.
abstract: OBJECTIVE
  Multidisciplinary clinics offer a unique approach to the management of patients with cancer. Yet, limited data exist to show that such clinics affect management. The purpose of this study was to determine whether consultation at a multidisciplinary clinic is associated with selection of active surveillance in patients with low-risk prostate cancer.
  
  
  METHODS
  The study comprised 701 men with low-risk prostate cancer managed at three tertiary care centers in Boston, MA in 2009. Patients either obtained consultation at a multidisciplinary prostate cancer clinic, at which they were seen by a combination of urologic, radiation, and medical oncologists in a concurrent setting, or they were seen by individual practitioners in sequential settings. The primary outcome was selection of active surveillance.
  
  
  RESULTS
  Crude rates of selection of active surveillance in patients seen at a multidisciplinary clinic were double that of patients seen by individual practitioners (43% v 22%), whereas the proportion of men treated with prostatectomy or radiation decreased by approximately 30% (P < .001). On multivariate logistic regression, older age (odds ratio [OR], 1.09; 95% CI, 1.05 to 1.12; P < .001), unmarried status (OR, 1.66; 95% CI, 1.01 to 2.72; P = .04), increased Charlson comorbidity index (OR, 1.37; 95% CI, 1.06 to 1.77; P = .02), fewer positive cores (OR, 0.92; 95% CI, 0.90 to 0.94; P < .001), and consultation at a multidisciplinary clinic (OR, 2.15; 95% CI, 1.13 to 4.10; P = .02) were significantly associated with pursuit of active surveillance.
  
  
  CONCLUSIONS
  Multidisciplinary care is associated with increased selection of active surveillance in men with low-risk prostate cancer. This finding may have an important clinical, social, and economic impact.
authors.affiliation: Harvard Radiation Oncology Program, Massachusetts General Hospital, Department of Radiation Oncology, 100 Blossom St, Cox 3, Boston, MA 02114, USA. aaaizer@partners.org
authors.forename: Ayal A
authors.initials: AA
authors.lastname: Aizer
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Paly
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Zietman
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Rao
authors.forename: Irving D
authors.initials: ID
authors.lastname: Kaplan
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Hirsch
authors.forename: Chin-Lee
authors.initials: CL
authors.lastname: Wu
authors.forename: Aria F
authors.initials: AF
authors.lastname: Olumi
authors.forename: M Dror
authors.initials: MD
authors.lastname: Michaelson
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Jason A
authors.initials: JA
authors.lastname: Efstathiou
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D006801:Humans; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010348:Patient Care Team; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen