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Back to 2016 Annual Meeting


Assessing the effect of multidisciplinary care on the quality of prostate cancer care
Jesse Sammon, DO1, Naveen Kachroo, MD2, Firas Abdollah, MD3, Matt Hayn, MD1, Moritz Hansen, MD1, Mani Menon, MD3, Quoc-Dien Trinh, MD4.
1Maine Medical Center, Portland, ME, USA, 2Henry Ford Hospital, Detroit, MI, USA, 3Henry Ford Hospital, Detroit, MI, USA, 4Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA.

Background: Multidisciplinary care (MDC) holds the promise of facilitating optimal patient cancer (PCa) management. MDC teams of trained specialists from different oncological disciplines have been developed to address these concerns and provide an objective, shared decision-making strategy to patient care. A number of single institution studies have shown that MDC leads to better diagnostic evaluation and disease classification, improved adherence to NCCN guidelines, improved patient outcomes as well as improved clinician and patient satisfaction. To our knowledge, no prior study has assessed the clinical impact of MDC in PCa care across multiple institutions for important outcome measures. This study assessed whether MDC resulted in improved oncological outcomes and quality of care (QOC) for those men treated for PCa.
Methods: Men treated for localized PCa between 1992 and 2009 were identified from the latest SEER-Medicare database. Patients were stratified according to those who saw both a urologist and radiation oncologist between diagnosis and definitive treatment within the first year of diagnosis (receipt of MDC) and those that did not. Cox proportional hazards models estimated the effect of MDC on all-cause and PCa-specific mortality Logistic regression analysis measured the impact of MDC on multiple QOC metrics.
Results: The final study cohort included 151, 488 men of whom 84,965 (56%) received MDC. MDC men were younger, married, white, had higher educational attainment and incomes and treated by high volume clinicians. MDC patients chose radiation therapy (RT) primarily (89%). For all men, receipt of MDC was associated with decreased all-cause mortality (HR 0.84, 95% CI 0.81-0.88, p<0.0001) and specifically for those treated by Observation (HR 0.75, 95% CI 0.70-0.82, p<0.0001). However, MDC was associated with increased PCa-specific mortality (HR 1.37, 95% CI 1.23-1.53, p<0.0001), especially amongst those receiving androgen deprivation therapy (HR 1.74 [95% CI 1.48-2.06], p<0.0001). They were nearly twice as likely to receive follow up with their treating physician. MDC patients receiving radical prostatectomy (RP) were more likely to receive adjuvant androgen deprivation therapy (ADT) (OR 2.4, p<0.0001) and adjuvant RT (OR 7.8, p<0.0001). MDC patients ≥75 with low risk disease and life expectancy<10 years were more likely to receive definitive treatment (OR 16.1, p<0.0001).
Conclusions: Overall, MDC was associated with decreased all-cause mortality but an increased PCa-specific mortality. Patients receiving MDC for their localized PCa are more likely to choose RT, receive definitive treatment and adjuvant therapy. They are more likely to be treated by high volume physicians and receive appropriate follow up with them. MDC however, results in an increased risk of potentially inappropriate over-treatment in a select cohort of patients.


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