Contemporary Patterns of Multidisciplinary Care in Patients With Muscle-invasive Bladder Cancer

Multidisciplinary clinics integrate the expertise of several specialties to provide effective treatment to patients. This exposure is especially relevant in the management of muscle-invasive bladder cancer (MIBC), which requires critical input from urology, radiation oncology, and medical oncology, among other supportive specialties.

In the present study, we sought to catalog the different styles of multidisciplinary care models used in the management of MIBC and to identify barriers to their implementation. We surveyed providers from academic and community practices regarding their currently implemented multidisciplinary care models, available resources, and perceived barriers using the Bladder Cancer Advocacy Network and the Genitourinary Medical Oncologists of Canada e-mail databases.

Of the 101 responding providers, most practiced at academic institutions in the United States (61%) or Canada (29%), and only 7% were from community practices. The most frequently used model was sequential visits on different days (57%), followed by sequential same-day (39%) and concurrent (1 visit with all providers; 22%) models. However, most practitioners preferred a multidisciplinary clinic involving sequential same-day (41%) or concurrent (26%) visits. The lack of clinic space (58%), funding (41%), staff (40%), and time (32%) were the most common barriers to implementing a multidisciplinary clinic.

Most surveyed practitioners at academic centers use some form of a multidisciplinary care model for patients with MIBC. The major barriers to more integrated multidisciplinary clinics were limited time and resources rather than a lack of provider enthusiasm. Future studies should incorporate patient preferences, further evaluate practice patterns in community settings, and assess their effects on patient outcomes.

Clinical genitourinary cancer. 2017 Dec 06 [Epub ahead of print]

Lauren C Harshman, Abhishek Tripathi, Matthew Kaag, Jason A Efstathiou, Andrea B Apolo, Jean H Hoffman-Censits, Walter M Stadler, Evan Y Yu, Bernard H Bochner, Eila C Skinner, Tracy Downs, Anne E Kiltie, Dean F Bajorin, Khurshid Guru, William U Shipley, Gary D Steinberg, Noah M Hahn, Srikala S Sridhar

Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. Electronic address: ., Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA., Penn State Milton S. Hershey Medical Center, Hershey, PA., Massachusetts General Hospital, Harvard Medical School, Boston, MA., National Cancer Institute, National Institutes of Health, Bethesda, MD., Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA., The University of Chicago, Chicago, IL., Fred Hutchinson Cancer Research Center, Seattle, WA., Memorial Sloan Kettering Cancer Center, New York, NY., Stanford University School of Medicine, Stanford, CA., University of Wisconsin, Madison, WI., Cancer Research UK/Medical Research Council, Oxford Institute for Radiation Oncology, Oxford, United Kingdom., Roswell Park Cancer Institute, Buffalo, NY., Johns Hopkins University School of Medicine, Baltimore, MD., Princess Margaret Cancer Centre, Toronto, ON, Canada.