The Importance of Multidisciplinary Collaboration in Urology Clinics - Neal Shore
June 8, 2022
Neal Shore, MD, FACS, is the Medical Director of the Carolina Urologic Research Center. He practices with Atlantic Urology Clinics in Myrtle Beach, South Carolina
Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts
Alicia Morgans: Hi, I'm so excited to be at AUA 2022 with Dr. Neil Shore to talk about the importance of multidisciplinary collaboration in urology clinics. Thank you so much for being here.
Neal Shore: Thank you.
Alicia Morgans: Well, I know you participated in sort of a multidisciplinary or multi-person presentation at AUA 2022, really thinking about different aspects of multidisciplinary care. Can you start us off? What were you guys talking about?
Neal Shore: Yeah, so great to be here in New Orleans in AUA 2022, and it was a plenary presentation today that was led by Lenny Gomella at Jefferson who's done really pioneering work on establishing the importance of the multidisciplinary team. And then myself and Mike Cookson. Mike, who was at Vanderbilt, who now chairs the University of Oklahoma. And, for myself, I've been a real proponent of multidisciplinary teamwork for many years.
And it all starts with having collaboration and collegiality with your colleagues. Maybe 15 years ago, we talked about the urologist talking to the rad onc a little bit, or the med onc a little bit. Prostate cancer, in particular, but all of GU oncology has become so much more complex. I think Lenny Gomella made the really good point that patients will feel better at the end of the day, even if they succumb to disease that they don't have regret if they had a medical oncologist, urologist, nuke med, rad on, pathologist, involved in their treatment decision-making.
How we scale it and do it in a way that's time efficient, that's economically consistent with the model that you're working under are some of the challenges, but at the end of the day, I think our north star is patient care and patient accessibility to all the best care. And over the course of time, the community, particularly, I find in the US, has really tried to emulate the academic model. So I think it's really best serving patients. Hearing the patient voice in these decision-makings becomes even more important. That's a real big initiative.
And then, of course, integrating clinical trials. Clinical trials, clinical trials, this is how we make advances. No secret. In 2003, we didn't really have any life-prolonging therapies in prostate cancer and now we have 12. It's kind of amazing. We have 8 or 10 in bladder cancer, advanced bladder cancer, 8 or 10, possibly even 12 in renal cancer.
We talked about the importance of integrating a genomic profiling, getting the pathologists on board and other ways that we deal with our person power shortages of physicians is getting APPs, advanced practice providers, on board.
So I was really pleased that the AUA honored us to have this session, and it's really very, very important. It's become more complex. I don't think any one person can do this anymore. It's a truly a team approach.
Alicia Morgans: It absolutely is. And as you said, our therapies are moving in this direction. Even things like trimodality therapy for bladder cancer, muscle invasive bladder cancer, or as you said, adjuvant therapy for kidney cancer. These are spaces where we can't do it alone, to your point. Certainly, a medical oncologist can't do surgery. And in many cases, the urologist is not going to give adjuvant chemotherapy or even adjuvant immunotherapy in the post-op period. So these are really, really important things.
I'd love to dig in a little more to the genetics and how that's become important, particularly in prostate cancer. But I can see it evolving in the other GU cancers as well. Were there suggestions or did your team have suggestions on how to optimize the integration of genetics and to really rely on the strengths of the different team members in that setting?
Neal Shore: Yeah, that's a great question. Well, genomic profiling, it's not about if you're going to do it. It's when are you going to start doing it because we have clinical utility. We have actionable things that we can do. If someone has an HRR mutation, they can benefit, potentially, from a PARP inhibitor. If they have MSI-high, they could benefit from the tumor agnostic indication for pembrolizumab. Numerous trials, looking at different gene alterations, PTEN loss, for example, and many others where we're looking at targeted therapies.
Clinical trial is a standard of care. I'll never get tired of saying that, but how do we get the testing done? The testing is... there's the germline component, the somatic tissue liquid. These aren't hard to obtain. The question then becomes is what do I do with the information as the clinician? How do I deal with the report? How do I translate it to patients? How do I translate it, potentially, to their families?
I think having a certified genetic counselor is the ideal scenario, but unfortunately, we don't have enough of them in the US, and I don't think we have enough globally and certainly not in the community. So then we have to think, "Okay, we have to become better educated." We can work through telemedicine to experts, whether it's the company that's providing the genomic profile or do it in-house, whether you have a great relationship with an academic center or just learn on your own and really take the courses and get better.
I think at the end of the day, it's all about providing excellence of service to patients and not being daunted by oh, lots of new acronyms, long lists of reports because I think we all have that within our heart and soul that we want to do the best we can.
Alicia Morgans: Well, I think that's the best message to end on, that working together we can do the best that we can do, and it really does take a team to have that best approach and to really optimize and prioritize the best outcomes for the patient, so thank you so much for sharing your expertise.
Neal Shore: My pleasure. Thank you.