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In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the USA. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urologic cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined.
Published by Elsevier Inc.
The changing healthcare environment will demand greater integration and coordination of care for patients. By incorporating systemic therapies into the practice of urologic oncology, our specialty has the opportunity to take the lead in this initiative. By learning how to deliver these therapies to patients in need, urologic oncologists likely will improve communication and trust, as patients often will already have a long and positive relationship with their urologist. In turn, this will likely lead to increased satisfaction with care and possibly improved outcomes. The development of comprehensive urologic oncology practices that include the administration of systemic therapy will maintain the relevance of the specialty and ultimately benefit our patients.
Copyright © 2012 Elsevier Inc. All rights reserved.
OBJECTIVE - It is recognized that multidisciplinary teams may improve management decisions for patients with malignancies. We prospectively studied the effect of such a multidisciplinary approach on the diagnosis and treatment decisions of patients newly presenting with urologic malignancies.
METHODS - Two hundred sixty-nine consecutive new patients presenting to our institution with an outside diagnosis of a urologic malignancy for diagnostic or treatment considerations (2007-2008). All cases were reviewed and discussed at a tumor board with all members of the different subspecialties present. Reevaluation of the outside diagnostic and treatment plan was undertaken. Based on this team review and approach, patients were classified based on changes in diagnosis and/or treatment.
RESULTS - Cohort was comprised of patients with the diagnosis of cancer of the prostate (34%), bladder (23%), kidney (35%), testicle (5%), and other (1%). Only 35% of patients had no changes in diagnosis or treatment, 38% had a change in diagnosis or treatment, 10% required further analysis (i.e., "other"), and 17% were N/A. Changes in diagnosis were most common in bladder (23%) and renal (17%) cancers. Changes in treatment were most common in bladder cancer (44%), followed by kidney (36%), testicular (29%), then prostate (22%) cancers. A stage effect on diagnostic and treatment considerations was also noted, especially for bladder cancer.
CONCLUSIONS - A multidisciplinary team approach affects the diagnostic and management decisions in a significant number patients with a newly diagnosed urologic malignancy, and thereby seems to have a clinical impact for many of our patients with urologic cancers.
Copyright © 2011 Elsevier Inc. All rights reserved.