Dr. See on Making Treatment Decisions
This commentary was written by Willaim See, MD, Medical College of Wisconsin urologic surgeon and chair of the Department of Urology.
Cancer constitutes an extraordinarily complex group of diseases. Tailoring management plans to fit the needs and circumstances of the individual cancer patient is among the most challenging of clinical undertakings. In the case of prostate cancer, patient age, overall health, medical history, family history, lifestyle priorities, tumor type and tumor extent are among the factors to be considered in customizing care recommendations. These and other factors combine to determine if a given prostate cancer needs treatment, if the cancer can be treated for cure, and which treatment option offers the best balance of risk vs. benefit. Without a systematic and comprehensive approach to these questions patients, can be overwhelmed by a bewildering array of management options and at times, seemingly contradictory recommendations.
A March 10, 2010, article from the LA Times offered patients sage advice to “do the same kind of background research that you might do in buying a car.” Regrettably, at present, patients can find out more information regarding a used car purchase than they can about the credentials, volumes and outcomes of a given hospital or physician. Against this backdrop, how does a cancer patient make an informed decision?
The Prostate and Urologic Cancer Program at the Froedtert & The Medical College of Wisconsin Clinical Cancer Center has taken a lead in publishing what we believe to be important measures of quality cancer care. During the 2008 calendar year, 100 percent of prostate cancer patients seen at the Froedtert & The Medical College Clinical Cancer Center underwent review of their management plan by a multidisciplinary group including urologists, radiation oncologists and medical oncologists. Sample chart reviews demonstrated that 100 percent of patients were informed of the availability of multiple management options (including “watchful waiting”). Ninety-five percent of patients either saw, or were offered an opportunity to see, a urologic oncologist and a radiation oncologist. As a consequence of this process, for prostate cancer patients 65 and older treated at the Clinical Cancer Center during the last six months, 42 percent chose radiation, 22 percent active surveillance (watchful waiting), 22 percent surgery, 12 percent prostate freezing, and 3 percent chose hormonal therapy.
These outcomes illustrate the critical importance of multidisciplinary care driven by National Comprehensive Cancer Center Care guidelines in optimizing management recommendations. As advocates for our patients we believe information is power, and we encourage them to do the background research required to reach an informed decision that takes into account their perspective and priorities. Primary care physicians can be important partners in this process. At the same time, academic cancer centers serve as invaluable resources to patients confronting a diagnosis of cancer.
William A. See, MD
Professor and Chairman
Department of Urology
Medical College of Wisconsin
Last Review Date: May 6, 2010