Multidisciplinary Care for Patients, a Book Interview - Alicia Morgans
October 16, 2022
Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts
Charles J. Ryan, MD, the President and Chief Executive Officer of The Prostate Cancer Foundation (PCF), the world’s leading philanthropic organization dedicated to funding life-saving prostate cancer research. Charles J. Ryan is an internationally recognized genitourinary (GU) oncologist with expertise in the biology and treatment of advanced prostate cancer. Dr. Ryan joined the PCF from the University of Minnesota, Minneapolis, where he served as Director of the Hematology, Oncology, and Transplantation Division in the Department of Medicine. He also served as Associate Director for Clinical Research in the Masonic Cancer Center and held the B.J. Kennedy Chair in Clinical Medical Oncology.
AUA 2022: Panel Discussion: What is the Optimal Multidisciplinary Team in 2022: Drafting for the Future
Charles J. Ryan: Alicia, I was fascinated to hear that, amidst all of everything you have going on, you recently published a book with Kelly Stratton on the multidisciplinary management of GU cancers. Tell us a little bit about what this book's about and the project in general.
Alicia Morgans: Well, thank you so much for asking. I think it's so important in what we do to work together collaboratively as surgeons, or urologists, radiation oncologists, medical oncologists, and all of the other people who are involved in the care team, including nutritionists, physical therapists, all of those supportive staff members to really ensure the best outcomes for our patients.
And so, this book addresses that need, and really thinks about where are the places where we might actually implement multidisciplinary care most effectively and, most importantly, where are the barriers, and how can we do that in a way that is consistent with our clinical practices, and clinical flows?
Charles J. Ryan: I think that in an academic center, what I've seen is multidisciplinary care is certainly possible, but sometimes it boils down to logistics, and space, and time. Getting people in the same space at the same time can be really hard, especially at a university hospital. And I can't imagine that it's easier in the community. So, how do you address these barriers?
Alicia Morgans: So, I think, for the most part, the book addresses the areas where multidisciplinary care can be most important, and most needed. For example, in prostate cancer thinking about bone health is something that urologists, and medical oncologists need to do collaboratively potentially with their NPs and PAs to really implement a structured and standardized way of thinking about that particular problem. That's one aspect, of course, of multidisciplinary care. But you could imagine for initial diagnosis of prostate cancer, or kidney cancer, or bladder cancer that a tumor board, whether it's virtual, or something that is an in-person collaborative clinical experience could be important.
So, there are different places where we need multidisciplinary care, the beginning, or during treatment, or maybe even towards the end. And there are different ways where we might implement that multidisciplinary care, depending on the place where we need the care, and the setting, and the practice that we actually have.
Charles J. Ryan: So, what's your recommendation to people listening, who are thinking, "I have an interest in bladder cancer, or prostate cancer, and I want to create a special clinic for this at my community, or at my center," what's your advice for how they might be able to pull that together?
Alicia Morgans: I think the most important thing is identifying the colleagues, and partners who are going to work with you in that effort, and really stating, "This is what our goal is. We're going to make a multidisciplinary care plan for these patients. And we're going to come together as a multidisciplinary care team."
Then, you could start to think about logistics. Is this a once-every-two-week tumor board? Is this a once-every-month tumor board? Is it a once-a-week tumor board? Is it a co-localized practice where everyone is at the same place at the same time? Or is this a virtual meeting where you can run patients at the end of the day, or engage in a virtual clinic throughout clinical days? Or is it really just coming together at a tumor board? There are lots of ways that we can implement it. But first, identifying the partners, and then identifying the strategy, and then having the ability to evolve that strategy as your practice needs, I think, is going to be important.
Charles J. Ryan: So, an important part of the book is that this is not focused on solely one cancer, it's bladder cancer and all GU cancers, I should say. Do you have a sense as to which of the GU diseases where a multidisciplinary approach may be either the most likely to be currently enacted, or where the benefits and the outcomes are best?
Alicia Morgans: I actually think that this could be across all GU tumors, and that's why we really took a broad stroke at this, or a broad brush to this problem. I think, obviously, kidney cancer is a great place where we have the opportunity potentially to consider clinical trials. In the neoadjuvant setting we, for many patients, will go on to surgery. And then, we might have the opportunity to engage in adjuvant clinical trials, or adjuvant therapies. And then, there's the metastatic setting where we might even use surgery despite having a metastatic patient. And that's, of course, a question still in flux.
In the prostate cancer setting, we're often faced with patients with localized disease, and a multidisciplinary care team can come together around that initial treatment decision for patients with localized disease, or even in patients with more advanced disease who may have complications of metastatic cancer, urinary obstruction, or cord compression that requires a multidisciplinary approach to really sorting that out. Bladder cancer is the same. Obviously, we can think about new adjuvant therapy, chemoradiation therapy. Lots of different settings where we might, for patients with muscle-invasive localized disease, work together as a team, and the metastatic setting as well. So, really all of these areas lead to that need.
would also say that, as I said before, bone health can be addressed in all of these settings. And other things are important too, whether it's exercise, lifestyle, nutrition, these are things that we might work together with our other clinical colleagues to address in all of these different disease settings, and across the spectrum of the disease journey.
Charles J. Ryan: So, you're integrating survivorship even into the multidisciplinary initial approach to the disease, which is fitting with the rest of the work that you're doing it seems.
Alicia Morgans: It is. And, of course, Dr. Stratton too worked together to put this together, we really collaborated closely. He's a urologist. And I think it was fitting to have people from two different specialties really lend their expertise equally in this contribution.
Charles J. Ryan: The book sounds like a really interesting project and a really important new resource for clinicians. Tell us a little bit about the team, and how the book came together.
Alicia Morgans: Yeah, well, thank you so much for asking because the book was written by just an army of colleagues, and collaborators who came together to each write a specific chapter of an area of expertise, often involving junior colleagues to work on this. So, it is a mix of really pragmatic, and practical stuff, as well as the learnings of some of our colleagues over many decades of caring for these patients. So I think that unique mix, and the collaboration of this group of experts was just a truly rewarding experience. And I think will be really, really helpful in clinical practices.
Charles J. Ryan: Well, congratulations, and thank you for bringing this resource to our attention and to our clinics.
Alicia Morgans: Thank you so much.