Treating Prostate Cancer: The Value of a Team Approach

Prostate cancer is not only a major health issue in large cities and academic centers but also in community hospitals and smaller healthcare settings. While the value of a multidisciplinary team (MDT) approach is well recognized in major cancer institutions, this model is equally vital in community healthcare settings. By fostering collaboration and communication across various departments, community healthcare providers can significantly improve patient outcomes.

Understanding the Challenges in Community Settings

Community hospitals often face unique challenges, such as limited resources, smaller staff sizes, and less access to cutting-edge technology. However, these challenges can be mitigated by implementing a coordinated approach to care. Even in resource-limited settings, a team approach can lead to more personalized, effective, and efficient treatment plans for prostate cancer patients.

“Discussions between surgeons, radiation oncologists, medical oncologists, together with the radiologists and the pathologists so that we can all discuss each individual case and put forward the information that we obtained from all the diagnostic tests and in conjunction try to make individualized recommendations to what we think is best to treat a given patient’s cancer,” Dr Albert Vargas, vice chair for Oncologic Imaging in the Department of Radiology at NYU, told SurvivorNet.

“Patients also have a major input into what type of treatment they receive. It’s very common for patients to be presented with the information that has been collected about their cancer, and for them to see a surgeon and for them to see a medical oncologist, and for them to see a radiation oncologist and then together explore what are the options for the treatment of their prostate cancer. And that can only be done in an informed way if all the diagnostic elements of the given cancer are provided in the most accurate way,” he adds. 

Building the Multidisciplinary Team in Community Hospitals

1. Primary Care Physician: Often, the primary care physician in a community setting is the first point of contact for patients. Their ongoing relationship with the patient positions them well to coordinate care and ensure that all specialists are informed of the patient’s broader health context. This continuity of care is vital in managing the long-term implications of prostate cancer treatment.
2. Urologist: In community hospitals, the urologist may serve as the central figure in prostate cancer management. Their role extends beyond surgery and diagnosis; they often coordinate with other specialists to ensure a comprehensive care plan. Regular communication with other team members is crucial, even if they are not on-site.
3. Medical Oncologist: For many community hospitals, medical oncologists might not be available in-house. Establishing a strong referral network with nearby cancer centers or oncologists who can consult remotely is essential. Community hospitals can leverage telemedicine to facilitate these collaborations, ensuring that patients have access to systemic therapies like hormone therapy and chemotherapy.
4. Radiation Oncologist: Access to radiation therapy might be limited in smaller settings, but that doesn’t diminish the need for close collaboration with radiation oncologists. Patients might need to travel to receive radiation therapy, making it vital for the primary care team to stay informed and involved in their treatment to ensure continuity of care.
5. Radiologist and Nuclear Medicine Specialist: Advanced imaging techniques may not be readily available in every community hospital, but partnerships with larger institutions can allow patients to access these services. Community hospitals should establish protocols for sharing imaging results and ensuring timely interpretation to avoid delays in treatment.
6. Pathologist: In smaller settings, the pathologist’s role is crucial in providing accurate and timely diagnosis. Regular meetings with the treating urologist and oncologist can help ensure that the pathology findings are clearly communicated and understood, guiding appropriate treatment decisions.
7. Nurse Navigator: Even in smaller hospitals, the role of a nurse navigator can be invaluable. This individual can help patients navigate the healthcare system, coordinate appointments across different locations, and ensure that the patient and their family understand the treatment plan.
8. Psychologist/Psychiatrist: Mental health support is often overlooked in community settings, but it is just as important as in larger institutions. Community hospitals can work with local mental health professionals to ensure that prostate cancer patients receive the emotional support they need, whether through direct counseling or referrals.
9. Dietitian: Community hospitals can offer nutritional counseling as part of the cancer care team. Dietitians in these settings can work with patients to manage the side effects of treatment and maintain overall health, even if resources are limited.

Strategies for Implementing a Team Approach in Community Hospitals

1. Leverage Technology for Collaboration: Utilize telemedicine and digital communication tools to connect with specialists who may not be available on-site. Virtual tumor boards, where different specialists can discuss complex cases, are one way to ensure that community hospital patients receive expert-level care without leaving their local area.
2. Establish Strong Referral Networks: Develop partnerships with larger institutions for referrals, particularly for services like radiation therapy, advanced imaging, and specialized surgery. These partnerships should be based on open lines of communication and mutual understanding of each other’s capabilities.
3. Regular Multidisciplinary Meetings: Even in a smaller setting, scheduling regular meetings where all relevant healthcare providers can discuss patient cases is crucial. These meetings ensure that everyone involved is up-to-date on the patient’s condition and that care is coordinated effectively.
4. Patient-Centered Care Coordination: The focus should always remain on the patient’s experience and outcomes. Coordinated care that reduces the need for repeated tests, unnecessary travel, or confusing treatment plans can greatly enhance patient satisfaction and adherence to treatment.

Education and Training: Continuous professional development is important, even in community settings. Providing staff with access to the latest guidelines, research, and training opportunities can help them stay informed about the best practices in prostate cancer care.