The Association of Community Cancer Centers recently surveyed its members and found a universal request for assistance in developing prostate cancer care programs. The ACCC responded by setting up pilot programs in the U.S. that focus on the following areas:
• Identify the need for prostate-specific care.
• Open lines of communication among providers.
• Develop a collaborative team approach to care.
• Provide guidance in planning and implementing a multidisciplinary program.
The first phase of the project was discussed at the 2009 ACCC meeting in Washington, DC, with a more recent update in July. The project also will be discussed this month at the 2009 ACCC National Oncology Economics Conference.
The different treatment options for prostate cancer can make it difficult to determine the most effective one, said Mary Lou Bowers, MBA, president and CEO of the Pritchard Group in Rockville, Md. “Many of the treatment options are equally effective but mutually exclusive. This is why a prostate cancer program, especially education about the disease and its treatment, must be patient-centered,” she explained. “It is critical that we collect real data about the relative merits of various treatments so we can give patients accurate information.”
Ms. Bowers noted that cancer centers participating in the project have been able to target patients’ individual needs: caregivers talk with patients about the aspects of treatment that patients fear most (incontinence, impotence) and encourage them to voice all of their concerns.
The ACCC program started at five institutions and has since expanded to 10 (see Table). The institutions involved were briefed on a model of a community-based prostate-specific cancer program and then implementation of the program was tracked. Ms. Bowers outlined five steps that are critical to the success of a prostate cancer care program.
Assess the need for the program
Administrators should obtain data on underserved populations and outmigration from the local area; convene patient focus groups to determine best treatment practices; and know the competition as well as what they offer in terms of prostate cancer treatment.
Improve communication
Ms. Bowers stressed that physicians and other caregivers must take into consideration a patient’s goals. Often, surgeons and radiation oncologists will be biased toward a particular treatment modality, but treatment should proceed sequentially and be based on what patients want. “The worst negative outcome is when a patient regrets that he didn’t get all the information he needed to choose a different course of treatment,” she said.
Establish a patient advocacy program
A patient advocate, also called a patient care coordinator, should serve as a neutral resource, providing education, sharing research data, and offering emotional support when necessary. The advocate should be available to the patient and his family throughout the entire treatment process.
Conduct research
A successful community prostate cancer program needs to track and analyze patient volume, outcome measures, complication rates, and patient satisfaction, and an ongoing budget review is needed to determine whether the program can be sustained long-term.
Engage in outreach
External outreach to the community is a given, but marketing efforts should involve reaching out to referring physicians and other medical colleagues.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
