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Multispecialty care teams can optimize the long-term management of patients’ cancer, comorbidities, and cardiovascular health.
New recommendations from the Prostate Cancer Cardiovascular (PCCV) Expert Network emphasize a multidisciplinary approach to care.
Gonadotropin-releasing hormone agonists are the most used androgen deprivation therapy (ADT) in prostate cancer; however, these agents have been linked to an increased risk of CVD, wrote Axel S. Merseburger, MD, PhD, lead author, and colleagues.
The PCCV Expert Network convened to identify strategies for addressing and managing CVD, emphasizing multidisciplinary care. The panel of experts included 14 urologists, three cardiologists, and one medical oncologist.
“It is important to note that the recommendations presented herein are supported by general agreement amongst experts rather than a formal assessment of consensus,” Dr. Merseburger and team wrote.
A Multidisciplinary Approach
The panel recommended implementing multidisciplinary care teams to optimize cardiovascular assessment and treatment planning. In addition to the urologist, these teams can include cardiologists, medical oncologists, radiation oncologists, general practitioners, and family physicians.
Currently, cardiologists are underrepresented on multidisciplinary care teams treating patients with prostate cancer.
“However, considering the substantial CVD burden in patients with [prostate cancer], there is a clear need for a shared-care approach,” experts said.
The authors advised that urologists should pre-identify cardiologists with experience in cardio-oncology to ensure patients receive timely care and referrals. General practitioners and family physicians can treat comorbid conditions such as diabetes and hypertension.
The panel also emphasized including uro-oncology nurses on the team, as multidisciplinary care teams that include nursing staff appear more effective than those without nurses.
Since patients typically coordinate their appointments, communication between providers on the team may be unorganized and fragmented. Digital tools, such as telemedicine, may help bridge this gap. Experts also encouraged urologists to proactively build relationships and referral networks with other specialists to facilitate patient access to timely, specialized care.
“Although establishing this network may require considerable upfront effort, it offers access to specialized guidance and diverse medical attention,” Dr. Merseburger and colleagues wrote.
Long-Term Management Considerations
The PCCV Expert Network went on to provide long-term care strategies for the multidisciplinary team.
Improving patient engagement can encourage long-term adherence and better outcomes, Dr. Merseburger and colleagues noted. They recommended that providers try to instill in patients a sense of empowerment during decision-making.
Clinicians should educate patients on cardiovascular health, test results, and other considerations, such as lifestyle goals during treatment. Adherence has also been linked to regular encouragement, acknowledgment of goals, and tailored advice from providers.
After starting therapy, the urologist should create a long-term care plan that includes monitoring the patient’s cancer, managing comorbidities, and ensuring patients adhere to their treatment. In addition, the urologist should select alternative treatment options if the patient experiences intolerable side effects on their current therapy.
According to the recommendations, the care plan should include proactive monitoring for cardiometabolic adverse events that may occur during treatment.
“For example, for patients who are at risk of QTc prolongation with ADT, baseline and serial electrocardiogram assessments are recommended,” Dr. Merseburger and colleagues wrote.
Primary care providers can monitor patient adherence and adverse events and support cancer surveillance. Experts advised urologists to proactively communicate with primary care clinicians and refer patients at high risk of CVD to cardiologists.
“Workflows for long-term [prostate cancer] management that tap into the expertise of multiple specialties not only provide the patient with comprehensive care but also ease the burden on urologists, so they may focus on providing optimal and uninterrupted oncological treatment,” experts advised. “Proactive collaboration and communication between health-care providers can drive positive change in the field of [prostate cancer] treatment and ultimately improve patient outcomes.”
Click here to read more about the panel’s recommendations.
