Bladder Cancer Multidisciplinary Clinic (BCMC) Model Influences Disease Assessment and Impacts Treatment Recommendations

Abstract

BACKGROUND: Despite established guidelines for bladder cancer (BC) management, significant treatment variability remains across the United States. OBJECTIVE: To report the impact of a tertiary center, bladder cancer multidisciplinary clinic (BCMC) on diagnostic evaluation and treatment recommendations in externally referred patients with BC. METHODS: Our BCMC clinic format includes simultaneous consultation with urologic, medical and radiation oncology, with real-time expert genitourinary pathology and radiology review. We retrospectively assessed all external referrals for concordance between outside radiology/pathology records and BCMC interpretation after central review and explored potential differences between outside treatment plan and BCMC recommendations. RESULTS: 233 patients with BC were referred to BCMC between the years 2014–2017. Complete radiographic and pathology data were available for 201 patients. Median age was 69 (Interquartile Range: 60–75) and 83% were performance status ECOG 0-1. After BCMC review of outside records, imaging interpretation was changed in 53 (26%) patients; pathology was changed in 59 (29%). Further diagnostic work-up was recommended in 85 (42%) patients. Overall, 56 (28%) patients had a change in their clinical staging. BCMC recommended treatment modification in 117 (58%) patients. Subsequent treatment plan was concordant with BCMC recommendations 91.5% of the time. CONCLUSIONS: BCMC resulted in critical radiology and/or pathology diagnostic changes in several cases, with frequent treatment modifications, underscoring the importance of multidisciplinary care in BC and the considerable contribution of real-time expert pathology and radiology review in diagnostic accuracy. Further studies are needed to confirm the proposed benefits and impact of BCMC on treatment response and patient outcomes.