Our first issue of 2017 emphasizes a well-known, yet an evolving and important, theme: optimizing the successful multidisciplinary collaboration amongst oncologic physicians; and furthermore, the importance of patient involvement, also known as, patient-physician shared decision making (and assuredly, successful integrated care). This multidimensional approach to decision making and treatment has numerous advantages in all phases of the patient care experience, the physician expectation of successful genitourinary oncology outcomes, and efficiency for the healthcare ecosystem. The authors of our three featured articles in this issue include the specialties of: urology, cardiology and nuclear medicine.
Urologists, Ashish Kamat, MD, MBBS, FACS and Janet Baack Kukreja, MD, MPH, have co-authored our cover story, “Enhanced Recovery After Surgery (ERAS) Radical Cystectomy and Urinary Diversion”. Radical cystectomy accounts for approximately 10,000 cases annually and may be associated with considerable patient morbidity and healthcare economic expenditures. The authors explain with clear detail how ERAS and the multidisciplinary approach involving surgeons, anesthesiologists, nurses, dieticians, allied health professionals ,and patients and their caregivers is crucial to optimizing the entire radical cystectomy patient care experience and how prior recommendations have been replaced by more efficient and evidence based pathways, which will optimize both patient clinical outcomes and enhance economic efficiencies. These two metrics are key to the future of our value based healthcare transition as legislated by the adoption of MACRA.
Cardiologist, Matthew Roe, MD, authors his expert perspective, “Assessment of Cardiovascular Risk With the Use of Androgen Deprivation Therapy for Prostate Cancer”, which reviews the concerns and risk analysis for instituting androgen deprivation therapy for patients who may also have cardiovascular morbidities and increased risk profiles; he reviews the known literature and the theoretical advantages and disadvantages for ADT selection, which should thus enhance additional preventative strategies to avoid complications of therapy and also augment additional patient physician discussion of all options of care. The issues discussed should cause oncologic physicians considering the use of ADT to not only consider consulting the primary care physician or cardiologist but also to review a prostate cancer patient’s cardiovascular risk profile.
Radium-223 is the first targeted alpha therapy approved by the US Food and Drug Administration which has demonstrated survival prolongation for patients with castration resistant prostate cancer. Nuclear Medicine Radiologist, Phillip Koo, MD, provides a concise review of the registration trial development for Radium 223, its well tolerated safety profile, the course of therapy for optimization, and the potential for combinatorial use with other approved CRPC therapies, while again emphasizing the benefits of multidisciplinary, integrative physician collaboration. Physicians dedicated to maximizing CRPC patient outcomes, especially for patients with bone metastases, and maintaining quality of life goals must continue to stay updated with the evolving published and presented most recent data, which Dr. Koo provides within this well written review
In concluding this first issue of 2017, we provide the Spotlight section which is focused on the 2017 ASCO GU meeting held in Orlando, Florida. On UroToday.com, over 90 different abstracts from the meeting are presented as well as plenary lectures and state of the art presentations on: prostate, bladder, kidney and testicular cancer.
Thank you for reading, Everyday Urology-Oncology Insights, and we look forward to our goal of continuing to provide our readers with original content which will hopefully advance GU oncologic care.
Neal Shore, MD, FACS