Multidisciplinarity and

the Prostate Cancer Unit

R. Valdagni ESO Prostate Cancer Programme Coordinator European School of Oncology

Div. Radiation Oncology 1 and Prostate Cancer Programme Istituto Nazionale dei Tumori, Milan

Decreases the time from presentation to treatment, reducing

errors, fragmentation, variability among MDs

Ensures application of evidence based guidelines and

improves diagnostic and therapeutic paths

Guarantees objective, unambiguous and well balanced

proposal of all available therapeutic and observational

strategies

Guarantees/facilitates timely access to physical and psycho-

emotional rehab programs

Helps improve management of disease recurrence and

guarantees timely access to support and palliative care

Helps improve outcomes

Favors enrollment in innovative or experimental protocols

Improves education of professionals involved in patient care

Increases patient satisfaction

Multidisciplinary Approach in Prostate Cancer: Benefits

Actually, multidisciplinary experiences clearly show that

the success or failure of a multidisciplinary approach

highly depends either on the

“ subjectivity of the actors ” involved in patients’ care

and/or on the “ structural elements ” which

can facilitate the work flow

The Prostate Cancer Unit is

the structural element

able to contain, address and harmonize the

multiprofessional management

of prostate cancer patients

Multidisciplinarity and the Prostate Cancer Unit

“Prostate Cancer Unit Initiative in Europe: a position paper by

the European School of Oncology”

Prostate Cancer Units Initiative in Europe

November 2012 → June 2015

ESO Task Force:

Chairs: H. Hummel, OECI – R. Valdagni, ESO

M. Aitchison EBU representative Royal Free Hospital, London

P. Albers University Hospital, Dusseldorf

D. Berthold Hospitalier Universitaire Vaudois, Lausanne

A. Bossi Institut Gustave Roussy, Villejuif

M. Brausi EAU representative, Carpi Hospital, Carpi

L. Denis Europa Uomo

M. De Santis University of Warwick, Cancer Research Unit, Coventry Queen Elizabeth Hospital Birmingham

L. Drudge-Coates EAUN representative, King’s College Hospital, London

G. Feick Europa Uomo

C. Harrison Greater Manchester Strategic Health Authority, Manchester

M. Hoyer ESTRO representative, University Hospital, Aarhus

D. Hollywood ESTRO past representative

M. Mason University School of Medicine, Velindre Hospital, Cardiff

V. Mirone Università Federico II, Napoli

S. Müller EBU representative University Hospital, Bonn

C. Parker Royal Marsden NHS Foundation Trust, Sutton

B. Tombal Cliniques Universitaires Saint-Luc, Brussels

E. Van Muilekom EONS representative, Netherland Cancer Institute, Amsterdam

C.N. Sternberg San Camillo and Forlanini Hospitals, Rome

M. Watson IPOS representative, Royal Marsden NHS Foundation Trust, Sutton

S. Wesselmann DKG, German Cancer Society representative, Berlin

T. Wiegel University Hospital Ulm, Ulm

Non Core Team

Imaging Specialist

Medical Physicist

Radiation Therapy

Technologist

Specialists in Palliative Care

Psychologist

Patient advocates

Clinical Trial Coordinator

Core Team

PCU Director

Urologists

Radiation Oncologists

Medical Oncologists

Pathologists

Nurse

Professionals dedicated to

data management

Documentation representative

Prostate Cancer Units: New Standards and Items

Recommended

Non Core Team

Physiotherapist

Sexual therapist or

urologist trained in

andrological urology or

certified andrologist or

clinical nurse specialist

Geriatrician

Multiprofessional Teams

ESO Task Force on Prostate Cancer Units initiative in Europe, CROH 2015

4 PCU

Critical mass

More than 100 newly registered cases of prostate cancer

discussed in the interdisciplinary and multiprofessional team

meetings treated or monitored by PCU each year

All immediate and deferred treatments and observational

protocols must be carried out under the guidance of the Unit’s

MD team

Adjuvant and palliative therapies as well as psychological support may be delivered in other settings

formally collaborating with the PCU in a network

Follow up of patients on active surveillance and watchful waiting should be delivered by the PCU’s

interdisciplinary and multiprofessional team or in other settings formally collaborating with the PCU in a

network

Patients’ follow-up care and rehabilitation should be guided by the PCU

ESO Task Force on Prostate Cancer Units initiative in Europe, CROH 2015

Prostate Cancer Units: New Standards and Items

5

PCU

Guidelines/

protocols

Evidence-based written guidelines used for diagnosis and for the

management of prostate cancer at all stages should be clearly

identified Protocols should be agreed upon by the core team members; new protocols and protocol amendments

should be discussed in the core team

7 PCU core team

general –

mandatory

requirements

Core team members spend an agreed amount of their time working with prostate cancer and undertake

continuing professional education on a regular base

At least one member of the each discipline of the core team should

participate in the interdisciplinary and multiprofessional meetings Members of the core team may mutually agree on documented exception to the rule.

Specialists of the non core team should participate on demand.

8 PCU core team

Urologist

Two or more urologists specially trained in prostate disease

diagnosis and treatment

At least 50 radical prostatectomy’s per year per unit

Spending approximately 50% or more of their working time

in prostate disease Contractual sessions should be guaranteed to attend clinics, interdisciplinary and multiprofessional team

meetings and audit meetings

9 PCU core team

Radiation

oncologist

Two or more specialized radiation oncologists specially trained in

prostate cancer radiotherapy or brachytherapy

At least 50 treatments (radical or adjuvant) per year per PCU

delivered either with external radiotherapy or BCT (HDR or LDR)

Spending approximately 50% or more of their working time

in prostate cancer (for both ERT and BCT) Contractual sessions should be guaranteed to attend clinics, interdisciplinary and multiprofessional team

meetings and audit meetings

ESO Task Force on Prostate Cancer Units initiative in Europe, CROH 2015

PCU Core Team

10

PCU core team

Medical

oncologist

Two or more specialized medical oncologists or specialists in

internal medicine, haematology and oncology, specially trained

in the treatment of prostate cancer

Seeing at least 50 prostate cancer patients per year

Spending approximately 50% or more of his/her/their working

time in prostate cancer Contractual sessions should be guaranteed to attend clinics, interdisciplinary and multiprofessional team

meetings and audit meetings

11

PCU core team

Pathologist One or more pathologists in charge of uropathology responsible

for prostate disease Contractual sessions should be guaranteed to attend interdisciplinary and multiprofessional team meetings

when requested and audit meetings

Devoting at least 50% of her/his /their working time to uropath. 12 PCU core team

Nurse One or more nurses dedicated to or specialized in urology Specially trained in providing care for patients at different stages of disease

Contractual sessions should be guaranteed to attend clinics, interdisciplinary and multiprofessional team

meetings and audit meetings

Devoting at least 75% of her/his working time to GU oncology 13 PCU core team

Professionals dedicated to

Data management

One or more professionals dedicated to data management

14 PCU core team

Documentation

representative

One documentation representative for the documentation

system for the PCU, monitoring the complete and correct compilation of patient data

25 PCU Clinics

Clinics for newly

referred prostate

cancer patients

First

possibility

At least one clinic per week should be available for newly-referred

prostate cancer patients. Recommended - These patients should be offered an appointment within 20 working

days of receipt of the referral.

The clinic can be monodisciplinary:

the patient is seen by the urologist or the radiation or the medical

oncologist and professionals able to offer psycho-social support

where available and handed out written information on possible

therapeutic/observational options. The nurse is available to provide additional information and support.

The case must be discussed in the Interdisciplinary and

Multiprofessional Team Meeting

ESO Task Force on Prostate Cancer Units initiative in Europe, CROH 2015

The Clinics

26 Clinics for newly referred prostate cancer patients

Second

possibility

The clinic can be multidisciplinary:

the patient is seen in sequence by the urologist, the radiation

oncologist, the medical oncologist (at least for locally advanced

and metastatic disease) and handed out written information on

possible therapeutic/observational options.

The nurse is available to provide additional information and

support.

The case must be discussed in the Interdisciplinary and

Multiprofessional Team Meeting.

ESO Task Force on Prostate Cancer Units initiative in Europe, CROH 2015

The Clinics

27 Clinics for newly referred prostate cancer patients

Third

possibility

The clinic can be multidisciplinary:

the patient is seen synchronously by the urologist, the radiation

oncologist, the medical oncologist (at least for locally advanced

and metastatic disease) and professionals able to offer psycho-

social support where available and handed out written

information on possible therapeutic/ observational options.

The nurse is available to provide additional information and

support.

The case must be discussed in the Interdisciplinary and

Multiprofessional Team Meeting.

ESO Task Force on Prostate Cancer Units initiative in Europe, CROH 2015

The Clinics

Want to know more?

prostate@eso.net

The aim of BCN is to facilitate the exchange of information and the

collaboration among clinical Centres exclusively dedicated to the

treatment of breast cancer. The Directory offers relevant information on

Centres with specific expertise in diagnosis, state-of-the-art treatment, and

care of breast cancer. All information published on the Directory is self-

assessed and remains under responsibility of the individual centre.

BCN provides no certification/ accreditation but Centres

certified/accredited by other entities are clearly indicated separately.

Following the example of Breast Centres Network

Breast Centres Network (www.breastcentresnetwork.org)

ESO is funding this initiative with its core funds

to avoid any bias and commercial influence

Europa Uomo has endorsed this process and is

contributing to the idea and its dissemination

Thank you for your attention