Multidisciplinary Specialty Care Benefits Patients with Genitourinary Cancers
At UF, patients with genitourinary cancers can receive multidisciplinary care from specialists in urology, medical oncology, radiation oncology and any other expert they need in one environment, as part of a group effort.
“For the more complicated cases, we enlist surgical specialists from our top-notch thoracic, lung and liver transplant, acute care surgery and cardiac surgery groups,” explained Padraic O’Malley, M.D., M.Sc., FRCSC, a clinical assistant professor in the UF College of Medicine’s department of urology. “We provide both robotic surgery and open surgery, and we can handle surgeries that would not be possible in some other centers.”
As an example, O’Malley cites the case of a patient with metastatic renal cell carcinoma who presented with pulmonary lesions, a renal mass with associated thrombus, and liver invasion. He was first seen in a multidisciplinary clinic with a uro-oncologist, medical oncologist and radiation oncologist. They decided the medical oncologist would prescribe immunotherapy and the radiation oncologist would treat the lung lesions.
Once repeat imaging showed the lesions had shrunk, robotic surgery was performed on the patient’s kidney, thrombus and liver. “For the surgery, the patient came in on a Friday and went home on Sunday,” O’Malley said.
In another case, a patient with testicular cancer received two lines of chemotherapy at another health system, then was referred to UF Health for surgery.
“He had a recurrent and residual disease, so a decision was needed about whether he should have third-line chemo or surgery,” O’Malley says. “In the end, he had surgery done by myself, a pancreatico–biliary surgeon and a thoracic surgeon all at once. But we had a lot of involvement with medical oncology and infectious disease. There was a large team effort for that patient.”
UF Health is participating in two clinical trials for patients with advanced or metastatic kidney cancers:
- PROSPER—a phase 3, randomized study of perioperative immunotherapy for locally advanced renal cell carcinoma that has not spread
- PDIGREE—an adaptive phase 3 trial of nivolumab and ipilimumab followed by cabozantinib in untreated metastatic renal cell cancer
“Most patients with advanced disease, whether they are in a trial or not, are going to need multimodal treatment,” O’Malley notes. “So, usually they will be seen in the multidisciplinary clinic or the case will be discussed at the tumor board. That way we get input from all the disciplines, and if the patient is a candidate for one of the trials, then we encourage that.”
There is good evidence that participation in a clinical trial leads to better outcomes, O’Malley explains. Patients are monitored particularly closely, they tend to be better informed about their health because they are involved in the decision-making process to enroll, and they are often getting tomorrow’s treatment today.
“We try to open up only a single trial in a disease space so we can enroll effectively,” O’Malley says. “Most of the trials we support are investigator-initiated, and a lot of them are cooperative group trials. UF Health prioritizes these trials. Our program has an exceptionally good track record for enrolling patients in trials. We offer trials for a number of GU malignancies, including kidney, bladder and prostate amongst others.
“A lot of people talk about using a team effort, but using it for complex surgical patients can be challenging,” O’Malley continues. “I think we’re successful because our surgeons and clinicians have a team mentality, and that goes a long way for patients.”