793 A multidisciplinary bladder cancer clinic delivers personalized care for complex bladder cancer patients

Hermanns, Thomas; Wei, Yi-ting; Bindi, B.; Satkunasivam, Raj; Athanasopoulos, P.; Boström, Peter J.; Kuk, Cynthia; Sridhar, Srinivas; Kwast, T. Van Der; Chung, Peter; Bristow, R.G.; Milosevic, M.; Fleshner, Neil; Jewett, Michael; Zlotta, Alexandre R.; Kulkarni, Gauri

doi:10.1016/s1569-9056(14)60781-8

Cited by 3 publications

(5 citation statements)

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“…As the decision of treatment for elderly MIBC patients is complex, a multidisciplinary approach should be considered. This can involve many different departments such as surgical, medical and radiation oncology, internal medicine, physical therapy and nutrition [ 15 16 ]. Advantages of a multidisciplinary bladder cancer clinic (MDBCC) include providing patients with discussions with a Urologic and Radiation Oncologists in addition to subsequent Medical Oncologist evaluation (if necessary) to make an appropriate treatment decision.…”

Section: Defining Elderly Patients and Life Expectancymentioning

confidence: 99%

“…Advantages of a multidisciplinary bladder cancer clinic (MDBCC) include providing patients with discussions with a Urologic and Radiation Oncologists in addition to subsequent Medical Oncologist evaluation (if necessary) to make an appropriate treatment decision. Additional investigations can also be made at his time [ 16 ]. The MDBCC was started in 2008 in Toronto with the aim to deal with complex BC cases in order to offer and discuss all available treatment options to patients including surgery or trimodality (radiotherapy, chemotherapy, and transurethral resection [TUR]).…”

Section: Defining Elderly Patients and Life Expectancymentioning

confidence: 99%

“…The MDBCC was started in 2008 in Toronto with the aim to deal with complex BC cases in order to offer and discuss all available treatment options to patients including surgery or trimodality (radiotherapy, chemotherapy, and transurethral resection [TUR]). Hermanns et al [ 16 ] found that following additional investigations in a MDBCC, 42% of patients had a change in stage and 29% had a change in treatment. While some patients did undergo RadC, others were offered a bladder preservation approach (trimodal therapy with chemoradiation).…”

Section: Defining Elderly Patients and Life Expectancymentioning

confidence: 99%

“…For instance in Toronto's MDBCC, a team of specialized oncologists can provide a thorough discussion with patients as to what the best care for them can be [ 16 ]. Through the MDBCC, MIBC patients can decide undergo trimodal bladder preservation treatments, with RadC as salvage therapy [ 70 ].…”

Section: Other Treatments For Elderly Bladder Cancer Patientsmentioning

confidence: 99%

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Treatment of bladder cancer in the elderly

Erlich

Zlotta

2016

Investig Clin Urol

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As the population ages and life expectancy increases in the human population, more individuals will be diagnosed with bladder cancer (BC). The definition of who is elderly is likely to change in the future from the commonly used cut-off of ≥75 years of age. Physiological rather than chronological age is key. BC care in the elderly is likely to become a very common problem in daily practice. Concerns have been raised that senior BC patients are not given treatments that could cure their disease. Clinicians lack quantitative and reliable estimates of competing mortality risks when considering treatments for BC. Majority of patients diagnosed with BC are elderly, making treatment decisions complex with their increasing number of comorbidities. A multidisciplinary approach to these patients may be a way to incorporate discussion from various disciplines regarding treatment options available. Here we review various treatment options for elderly patients with muscle invasive BC and nonmuscle invasive BC. We include differences in treatments from robotic versus open radical cystectomy, various urinary diversion techniques, chemotherapy, radiation therapy and combination treatments. In clinical practice, treatment decisions for elderly patients should be done on a case-by-case basis, tailored to each patient with their specific histories and comorbidities considered. Some healthy elderly patients may be better candidates for extensive curative treatments than their younger counterparts. This implies that these important, life-altering decisions cannot be solely based on age as many other factors can affect patient survival outcomes.

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Section: Defining Elderly Patients and Life Expectancymentioning

confidence: 99%

Section: Defining Elderly Patients and Life Expectancymentioning

confidence: 99%

Section: Defining Elderly Patients and Life Expectancymentioning

confidence: 99%

Section: Other Treatments For Elderly Bladder Cancer Patientsmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of bladder cancer in the elderly

Erlich

Zlotta

2016

Investig Clin Urol

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“…[3][4][5] Previous studies have demonstrated that multidisciplinary care results in changes in diagnosis and treatment plans for many bladder cancer patients. 6,7 Our institution initiated a MDBCC in 2008, providing an opportunity to evaluate whether its initiation impacted the temporal patterns of NAC use in patients undergoing RC for MIBC. Our hypothesis was that NAC would be increasingly used over time, particularly following the initiation of the MDBCC.…”

Section: Introductionmentioning

confidence: 99%

The initiation of a multidisciplinary bladder cancer clinic and the uptake of neoadjuvant chemotherapy: A time-series analysis

Nayan

Bhindi

et al. 2016

CUAJ

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Introduction: While level 1 evidence supports the use of neoadjuvant chemotherapy (NAC) for patients with muscle-invasive bladder cancer (MIBC), its uptake has been underwhelming, even in academic centres. Our aim was to determine if the initiation of a multidisciplinary bladder cancer clinic (MDBCC) in 2008 at our institution, where patients are assessed simultaneously by bladder cancer-focused urologists and radiation oncologists with easy access to a medical oncologist, was associated with an increased use of NAC. Methods: Patients with MIBC initiating treatment between July 2000 and June 2013 were identified and classified by academic year (July 1 to June 30). Time-series analyses using interventional autoregressive integrated moving average (ARIMA) models with ramp intervention functions were then conducted. A sensitivity analysis was performed on clinical N0 patients. Results: The cohort included 278 patients: 168 from 2000-2007 and 110 from 2008-2012 (academic years). Forty-two (15.1%) patients received NAC and 74 (26.6%) received adjuvant chemotherapy (AC). Overall the proportion of patients receiving NAC increased from 7.7% before the MDBCC to 47.6% in 2012 (Interventional ARIMA p=0.036). The results were similar when restricting to cN0 patients (p<0.001). NAC use gradually increased over time regardless of MDBCC attendance, although the proportion of patients receiving NAC appears to have risen more sharply among MDBCC attendees. Conclusions: At our institution, the initiation of the MDBCC was temporally associated with increased use of NAC. In addition to multidisciplinary collaboration, having a critical mass of NAC physician advocates and support from institutional leaders are essential to the uptake of NAC.

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