Multidisciplinary care critical to treatment
It's great to be armed with scientific evidence, but it does no good if the patients who could benefit from this evidence are not referred to you for care. This is a particular concern of radiation oncologists who worry that they are not even getting the chance to discuss radiotherapy with prostate cancer patients who could benefit from such treatment.
"I still get patients [with a biochemical recurrence] who were eligible for treatment," explains Gregory Swanson, MD, a radiation oncologist and an associate professor in the departments of radiation oncology and urology at the University of Texas Health Sciences Center in San Antonio. "They had high-risk findings and their urologists didn't discuss [the option of radiotherapy] with them, and now they have a rising PSA [prostate-specific antigen] level."
Fortunately, such patients are rare for Swanson because he works in a multidisciplinary clinic where radiation oncologists do joint clinics with urologists, but he says this type of arrangement is rare, especially in community settings. "Urologists typically operate in a vacuum. They have their practices, and they make the decisions. This is where there is a fundamental difference between prostate cancer and breast cancer," says Swanson, pointing out that with breast cancer it is a standard of care for women to consult with a medical oncologist — at least. "So there is an oncologist arbitrator who gets to look at the case and say that here are the things that might be of benefit."
Patients are better informed
At Emory University School of Medicine in Atlanta, there is a multidisciplinary tumor board, and radiation oncologists do annual patient outreach sessions with urologists and medical oncologists. However, most prostatectomies in Georgia are done in the community without patients having an opportunity to receive multidisciplinary guidance, says Peter Rossi, MD, an assistant professor in the departments of radiation oncology and urology at Emory.
"It is not a no-brainer to do one [type of treatment] or another, but I think by seeing a radiation oncologist or perhaps a medical oncologist, the patient is going to be best informed," he says. "Not everybody needs treatment, but the right patient stands to benefit."
Ashesh Jani, MD, an associate professor of radiation oncology at Emory, agrees that more multidisciplinary discussions are a good idea, but he also is heartened to see many more patients taking it upon themselves to become educated about their various treatment options. "They log onto the Internet and read a lot more about prostate cancer…so they are often well-aware of their options," he says. "It becomes more of a discussion of what the relative merits of each option are, and what the side effects are; and in the context of the good efficacy of many of these modalities, the patients often make their decisions based on side effects."
It's great to be armed with scientific evidence, but it does no good if the patients who could benefit from this evidence are not referred to you for care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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