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Towards the multidisciplinary management of prostate cancer patients: the

PerSTEP Project experience


The multidisciplinary management is acknowledged as the best approach to cancer
patients. The experience and knowledge of multiple specialists become also
fundamental in the care of prostate cancer (PC) patients who, depending on the state,
can be addressed to surgery, radiotherapy, brachytherapy, hormonal therapy,
chemotherapy, active surveillance and watchful waiting. The interaction of urologists,
radiation oncologists, medical oncologists, pathologists, psychologists, imaging
specialists as well as physiotherapists, geriatricians and nurses enables to put the
patients at the center of the path of care, offer them objective, not contradictory
information on ones options, reduce the number of consultations and favour
individualized proposals.
On this assumption the Italian Society for Urologic Oncology (SIUrO) and the Board of
Medical Oncology Directors (CIPOMO) decided to support PerSTEP, an educational
project aimed to promote the cultural and organizational switch to multidisciplinarity
and multiprofessionality in Italy.
Started with a phase 1 in 2012, a phase 2 was opened in June 2013 following the
requests to participate received from 23 centers (Table 1).
Summary of the activities accomplished within PerSTEP:
1. collection of information on the centers organizational models and personnel
involved in the care of PC patients;
2. meetings with the centers;
3. communication through newsletter and press releases.
The collection of information enabled to have a detailed picture of the working models
applied by the centers, which pointed to a rather multivariate situation. In fact, some
centers were already organized according to formalized multidisciplinary models,
others enjoyed good collaboration and relations among specialists, others worked in
monodisciplinary setting and requested specialistic consultations occasionally. The
multifaceted scenario was stimulus to the centers already organized multidisciplinarily
to improve their organizational models and to the centers working in a
monodisciplinary setting to start the reorganizational process.
The meetings with the centers allowed to share information and experiences of the
individual centers as well as published in the literature and trace minimal
requirements to favour the switch to multidisciplinarity:
1) involvement of the Directors (general, scientific, administrative, depending on
the center) to have the support in the organizational process
2) involvement of the Directors of the specialties involved in the path of care to
have the support in the organizational process and in the team building
3) identification of a team leader within the multidisciplinary team
4) adoption of evidence-based guidelines and elaboration of paths of care
5) evaluation of the possible multidisciplinary activities to be implemented (i.e.
multidisciplinary clinics, case discussions/tumor boards) and the different
modalities (i.e. for multidisciplinary clinics synchronic vs in sequence

interaction; for case discussions: vis vis vs virtual meetings), based on the
personnel available and the time that can dedicate to the tasks
6) activation of case discussions/tumor boards as starting point of the
reorganization process
The meetings were also the occasion to share problems encountered by the centers
such as:
1) resistance towards the multidisciplinary management of patients
2) not univocal interpretation of guidelines
3) no formalized collaboration to overcome the unavailability of a particular
specialty
4) unavailability of contractual time to attend multidisciplinary activities
The communication plan enabled to promote sensibilization actions on the importance
of the multidisciplinary approach and include new centers.
Last updated December 2014, PerSTEP produced marvelous results such as:
1)
2)
3)
4)

good interaction among centers


formalization and update of 6 PC Units
constitution of 7 new multidisciplinary teams
activation of 10 tumor boards

Further effort is nevertheless needed to support the cultural and organizational change
towards a multidisciplinary and multiprofessional management of PC patients.

A special thank to SANOFI for supporting the communication plan

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