New Medicare rules require MDT meetings for prostate cancer patients

GU cancer

By Michael Woodhead

3 Nov 2020

Revised Medicare criteria have been introduced that require men diagnosed with prostate cancer to have multidisciplinary review before undergoing radical prostatectomy.

The new MBS item explanatory notes, introduced from 1 November state that patient management for radical prostatectomies should include multidisciplinary team review with both a radiation oncologist as well as a urologist.

The changes were recommended by the MBS Review Taskforce to ensure that prostate cancer patients “have access to sufficient and balanced information in order to make an informed decision about their cancer management and treatment options,” according to a Medicare Fact Sheet

They require that a record of a patient’s decision to not accept a referral to a radiation oncologist (from the urologist or GP) should be clearly documented in the patient’s medical record.

The revised MBS items also require  patients to have long consultation with the operating surgeon within six months prior to surgery to discuss and provide written information on guideline-endorsed treatment options prior to deciding treatment.

In its report, the MBS Review Taskforce recommended that patients with prostate cancer should ideally be reviewed by a multi-disciplinary team before a treatment decision is made.

The multi-disciplinary team should involve radiation oncologists, medical oncologists (for adjuvant or therapeutic approaches) and other disciplines such as urology nurses, exercise physiotherapists, exercise physiologists, physiotherapists, psychologists, pathologists, radiologists, it suggested.

“It is critically important for all prostate cancer patients, especially those who are newly diagnosed, to have access to sufficient, balanced and personalised information to make an informed choice about their cancer management and treatment options,” it said.

“This is particularly important because two of the major treatment options for intermediate and advanced prostate cancers (surgical prostatectomy and radiation therapy) have different side-effect profiles, which affect patients’ quality of life differently depending on their age, lifestyle and expectations.”

The Taskforce said a multidisciplinary review would be more valuable than two separate consultations with a urologist and a radiation oncologist, “because divergent opinions can be constructively discussed and debated among the multidisciplinary team’s members.”

Dr Lance Lawler, President of the Royal Australian and New Zealand College of Radiologists (RANZCR) said the changes would promote best practice by ensuring that men diagnosed with prostate cancer fully understand the advantages and disadvantages of both surgery and radiation therapy.

“Surgery and radiation therapy are both equally effective but do cause very different side effects. Patients, surgeons and radiation oncologists together need to inform these decisions and men must be empowered to have input into their preferences.”

Dr Stephen Mark, President of the Urological Society of Australia and New Zealand (USANZ) said the Society supported the changes to promote informed decision making regarding management of a newly diagnosed prostate cancer.

“Some men will be best served by active surveillance whereas others will benefit from active treatment whether surgery, radiation or radiation with hormonal therapy. Treatment decisions should be individualised based on cancer risk and consideration of potential consequences of treatment,” he said.

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