Open Access

ARTICLE

Enhancing bladder cancer care through the multidisciplinary clinic approach

J. Ryan Mark¹, Leonard G. Gomella¹, Costas D. Lallas¹, Katherine E. Smentkowski¹, Anne Calvaresi¹, Nathan Handley², Robert B. Den³, Patrick Mille², William J. Tester², Jean Hoffman-Censits⁴, Adam P. Dicker³, Edward Klonicke¹, Ethan Halpern⁵, Peter McCue⁵, W. Kevin Kelly², Edouard J. Trabulsi⁶

1 Department of Urology, Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
2 Department of Medical Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
3 Department of Radiation Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
4 Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland, USA
5 Department of Pathology and Radiology, Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
6 Department of Urology, Jefferson-Einstein Health, Philadelphia, Pennsylvania, USA
Address correspondence to Dr. J. Ryan Mark, Department of Urology, Thomas Jefferson University, Sidney Kimmel Cancer Center, 1025 Walnut Street, Philadelphia, PA 19107 USA

Canadian Journal of Urology 2023, 30(3), 11526-11531.

Abstract

Introduction: We report the impact of our 25-year multidisciplinary care delivery model experience on patients with muscle invasive bladder cancer treated at our National Cancer Institute (NCI)-designated Sidney Kimmel Cancer Center at Jefferson University. To our knowledge, our multidisciplinary genitourinary cancer clinic (MDC) is the longest continuously operating center of its kind at an NCI Cancer Center in the United States.
Materials and methods: We selected a recent group of patients with cT2-4 N0-1 M0 bladder cancer seen in the Sidney Kimmel Cancer Center Genitourinary Oncology MDC from January 2016 to September 2019. These patients were identified retrospectively. SEER-18 (Surveillance, Epidemiology, and End Results) database, November 2019 submission was queried to obtain patients with similarly staged disease diagnosed between 2015 and 2017. Completion rates of radical cystectomy, use of neoadjuvant therapies, and survival outcomes were compared between the two cohorts.
Results: Ninety-one patients from the MDC form this time period were identified; 65.9% underwent radical cystectomy and 71.8% received neoadjuvant therapy in the form of chemotherapy, immune checkpoint inhibition or a combination of the two – higher than reported national trends for neoadjuvant therapies. Progression of disease was seen in 24.2% of patients. A total of 8675 patients met inclusion criteria in the SEER database. Rates of radical cystectomy were significantly higher in MDC patients when compared to SEER derived data (65.9% vs. 37.7%, p =< 0.001). MDC patients had significantly better cancer-specific survival (mean 20.4 vs. 18.3 months p = 0.028, median survival not reached).
Conclusion: Our long term experience caring for patients with genitourinary malignancies such as bladder cancer in a uniform multidisciplinary team results in a high utilization of neoadjuvant therapies. When compared to a contemporary SEER-derived cohort, multidisciplinary patients were more likely to undergo radical cystectomy and had longer cancer-specific survival.

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