Shared insight on the value of multidisciplinary care and its current state in cardiovascular disease and prostate cancer.
Bhavesh Shah, RPh, BCOP: In oncology, we’ve already seen cross-collaboration across multiple specialties in managing our patients. We do this already for patients with breast cancer, who receive anthracyclines. We make sure if they have a preexisting cardiovascular disease that we would have close collaboration with a cardiologist. When we have a patient with osteoporosis, it’s not the prostate oncologist who’s managing the patient for the osteoporosis but the endocrinologist. Unless they have metastatic to the bone, then the oncologist takes on that patient. But there’s already this model existing where we’re cross-collaborating with multidisciplinary specialty providers to manage oncology because it’s definitely becoming a complexity where patients are living longer and then seeing adverse effects. Even some drugs are causing patients to develop diabetes. Or we’re giving them drugs that are requiring significant adjustment in their diabetic medications. But you know that this isn’t the expertise of an oncologist. This is already happening. Having an alignment because we also see the cardiology providers have guidelines they abide by. Essentially, having that incorporated into their guidelines would create better education and collaboration with cardiologists and other disciplines that we may need to collaborate with in managing not just prostate cancer.
John L. Fox, MD, MHA: All of us would like to have a holistic approach to our care where we have multiple specialists opining on what the best therapy is. The reality is that most patients don’t get that holistic multispecialty approach to their treatment decision-making. It’s usually left to the urologist who’s initiating treatment and, sometimes, subsequently a referral to a medical oncologist. What would get us to the point where we had multispecialty approaches? It’s complicated because running a multidisciplinary clinic is expensive, and it’s not well reimbursed. In the near future, it’s unlikely that we’re going to have cardiologists involved in this decision-making process. It’s still possible if we increase awareness of cardiovascular risks: men die from cardiovascular disease with prostate cancer and not from prostate cancer.
We talked earlier about the role of decision-support tools at the point of care. We talked about the role of guidelines, pathways, and professional society recommendations. But I suspect that for the patient with metastatic castrate-resistant prostate cancer, it’s unlikely we’re going to have multispecialty clinics in the near future.
Maria Lopes, MD, MS: This is the ultimate wish: having a multidisciplinary approach to the management of the patient who has prostate cancer. Also, the shared decision-making component that does need to exist helps patients understand their options. But who owns the patient when they have cancer? Especially if they have long survival, which is great news. It may be the PCP [primary care provider], the oncologist, or the urologist early on.
How can we have a more integrated team-based approach? It’s important to educate care managers as they’re interacting with patients and caregivers but also multiple providers or specialists. To be able to direct the proper education, to be able to also have the right risk tools, to understand the context of patient age and risk factors, [and to] make the appropriate treatment selection so that at the end, we can optimize care and outcomes. Not just focused on siloed care but comprehensive care.
Transcript edited for clarity.