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SKCC GU Multidisciplinary Clinic Celebrating 25 Years
SKCC GU Multidisciplinary Clinic
Celebrating Years
Our Sidney Kimmel Cancer Center Genitourinary Multidisciplinary Clinic (GU MDC) was founded in 1996 by Dr. Leonard Gomella, Urology Chair at Jefferson and Dr. Richard Valicenti, now Chair of Radiation Oncology at University of California Davis in Sacramento, California. The 25th year of operation took place in 2021. The GU MDC was founded less than a year after the Sidney Kimmel Cancer Center received its initial NCI Cancer Center designation.
Our Multidisciplinary Genitourinary clinic we believe was the first formally described in the literature and is one of the best known programs of any of the NCI-designated Cancer Centers in the United States. Each week, urologists, medical oncologists, radiation oncologists and a variety of support staff evaluate patients with urologic malignancies in a coordinated real time clinical setting. A dedicated navigator helps to streamline the clinical care. Prostate, bladder and kidney cancer are the top malignancies treated based on overall tumor frequency but other cancers, such as penile, testicular and adrenal malignancies are also seen.
In addition to being one of the first of its kind (1), the program boasts many accomplishments. These are summarized in the accompanying time line. Noteworthy accomplishments include the first publication in 2010 demonstrating this combined care model improves survival outcomes in high-risk prostate cancer (3), the spinoff development of a Small Renal Mass Multidisciplinary Clinic (2) and the first Men’s Genetic Risk Program incorporating testing and counselling into a prostate cancer clinic in 2014 (4). In 2013, Men’s Health Magazine identified the Sidney Kimmel Cancer Center as one of the top 20 hospitals for prostate cancer care in the U.S. with our clinical team notes to be closely linked with basic scientists who work in the Sidney Kimmel Cancer Center research labs (see page 39). Our team published one of the first books in this area of multidisciplinary prostate cancer care. Prostate Cancer: A Multidisciplinary Approach to Diagnosis
Members of the SKCC GU MDC team including clinicians, residents, fellows and support staff gathered for a 25-year commenerative photo. In the front row are Dr. Adam Dicker, Radiation Oncology Chair, Dr. Kevin Kelly, Director of Solid Tumor Oncology for the Cancer Center and Dr. Leonard Gomella, Urology Chair representing the three core specialties who participate in the GU MDC. Our long standing pathologist Dr. Peter McCue and radiologist Dr. Ethan Halpern are seen behind Dr. Kelly. Dr. Andy Chapman, Acting Director of the Sidney Kimmel Cancer Center, and Alex Khariton, MBA, Vice President for Cancer Services, joined in the occasion. Radiation Oncologist Dr. Bobby Den has been a long time contributor and has led many clinical trials. Dr. Veda Giri leads the genetic testing, and Dr. Ed Trabulsi is curently the Clinical Director of the GU MDC with Cyrstal Sypherd, CPHT as navigator. Brian Ward coordinates the Small Renal Mass GU MDC along with Drs. Costas Lallas and Mark Mann. 6 Year in Review
Key SKCC individuals in this 1996 founding members photo include Dr. Leonard Gomella (4th from right), Dr. Richard Valicenti (3rd from left) and Dr. Adam Dicker (2nd from left). Also seen are the late Dr. S Grant Mulholland, former Jefferson Urology Chair, Dr. Steve Strup now Chair of Urology at the University of Kentucky and Dr. Mo Ismail Chief of Urology at the Wilmington, VA Medical Center. A photo to commemorate the 10-year anniversary of the GU Multidisciplinary Clinic in 2006. Across the front row from left to right Dr. Adam Dicker, Dr. Richard Pestell, SKCC Director, Mr. Tom Lewis former TJUH CEO, Drs. Leonard Gomella, Richard Valicenti and Walter “Wally” Curran, Clinical Director of the Cancer Center. Some notables to pick out in the photo include our current Urology Nurse Practitioner Darlene Bewick, Drs. Costas Lallas, Deb Glassman, and Ed Trabulsi.
A 2015 photo of some of the key GU MDC clinical team members. From left to right, Kathy Burns, Drs. Jianqing Lin, Adam Dicker, Kevin Kelly, Bobby Den, Leonard Gomella, Mark Hurwitz, Ed Trabulsi, Costas Lallas, MaryKate Cellmer and Dr. Jeannie Hoffman-Censits.
In 2019 a “Meet the Team” photo was taken outside of the Bodine Center for Cancer Treatment. The Bodine Clinic has been the home base for the GU MDC since its inception. Some new additions in this photo include Dr. Veda Giri, genetic counselor Laura Gross, urologic oncologists Drs. Mark Mann and Ryan Mark. Nurse practitioners who support the clinic include Ann Donnelly and Anne Lizardi-Calvaresi along with long time GU MDC Coordinator Joanne Anderson.
Dr. Adam Dicker, along with other members of the GU Multisdisciplinary team, published Prostate Cancer: A Multidisciplinary Approach to Diagnosis and Management in 2014. This book highlighted many of the principles of multidisciplinary prostate cancer care developed in our clinic (Demos Medical/Springer). Many other chapters and monographs have been written about details of our operation and overall experience in other books and journals.
Jefferson’s Kimmel Cancer Center 2013 Men’s Health Magazine acknowledgement for best prostate cancer care.
The SKCC Multidisciplinary Clinic has set the standard...serving as the benchmark for national comparison.
Andrew Chapman, DO, FACP
and Management by Dr. Adam Dicker and associates was published by Demos Press in 2014. The optimum approach to presenting the concept of active surveillance to men with low risk prostate cancer was developed at the GU MDC in collaboration with Dr. Ron Myers (5). The demonstration of our successful multidisciplinary collaboration was one of the reasons that the Philadelphia Prostate Cancer Biome project came into existence. The Biome project supports multidisciplinary basic science translational research (see page 18).
Our multidisciplinary program has served as a model for many other centers across the United States, and has become a common approach in European countries where they often refer to these as “Prostate Cancer Units.” See the comments by Prof C.H. Bangma from Erasmus University Medical Center in The Netherlands on page 11 for the European perspective on our GU MDC. The specific design of each multidisciplinary clinic, with many focusing on prostate cancer, can vary. This is now considered a standard approach to follow at many academic cancer centers. Many other centers that have published in this area of multidisciplinary care suggest that simultaneous encounters in a real-time clinic setting are becoming commonplace and optimize the clinic experience for all involved including the patient and their family. A recent addition to our program is the option for cases to be referred to a separate SKCC Molecular Tumor board for further review.
The Sidney Kimmel Cancer Center now has 11 other specialty disease specific multidisciplinary clinics in operation with each one suited to the needs of the patients and the disease specialists involved. Our overall multidisciplinary effort at Jefferson is coordinated by Valerie Csik, MPH, CPPS Director of Quality and Care Transformation for the Sidney Kimmel Cancer Center. The SKCC GU Multidisciplinary concept originally developed in the mid-1990’s initially focused on the care of men with prostate cancer. The reasons were simple: the treatment options and decisions for prostate cancer can be extensive and, at times, controversial. The benefits of the MDC concept include the potential to improve patient outcomes, to provide patients with convenience of seeing multiple specialists during one visit, to enhance education of trainees and staff, to improve clinical trial accrual and to allow standardization of data collection. Clinical trial opportunities, pathology and imaging review during a pre-clinic conference have become our standard practice with the current operational structure of the GU MDC is shown in the accompanying figure on page 11. Details on how to establish a similar GU MDC are available in an upcoming book (Mark JR, Gomella LG. Creating a Multidisciplinary GU Cancer Clinic. In: Urologic Oncology: Multidisciplinary care for patients. Ed. Stratton KL, Morgans, AK. 2022. Springer.)
Sidney Kimmel Cancer Center Receives NCI Designation SKCC Multidisciplinary Clinic design first published (1)
Small Renal Mass Clinic splits off from GU MDC (2)
SKCC GU Multidisciplinary Clinic Established by Drs. Leonard Gomella and Richard Valicenti
10-year MDC Gala celebration at the Hyatt on Broad Street with guest speakers and scientific program
In 2016, the GU MDC team received the Sidney Kimmel Medical College Dean's award for Team Science. From left to right (Front Row) Dr. Peter McCue, GU MDC Pathologist since 1996, Drs. Jianqing Lin, Costas Lallas, Jean Hoffman-Censits. (Back Row) Dr. Ethan Halpern, GU MDC radiologist since 1996, Drs. Mark Hurwitz, Kevin Kelly, Bobby Den and SKMC Dean Dr. Mark Tykocinski. Department Chairs Dr. Adam Dicker and Leonard Gomella who nominated the team were also acknowledged at the Union League ceremony. (Dr. Trabulsi was unavailable). LEFT: Participants in the 10 year GU MDC Symposium celebration in 2006 included members of the Department of Urology and the SKCC along with visiting professors Dr. Dan Petrylak from Columbia and Dr. Mike Koch from Indiana University.
ABOVE: The 10-year anniversary in 2006 was marked by a dinner symposium with guest speakers.
First Prostate Cancer Clinic Genetic Counseling Program launched within the MDC by Dr. Veda Giri (4). GU Multidisciplinary team receives SKMC Dean's Award
ASCO GU 2020: Demonstration that the MDC approach can improve neoadjuvant chemotherapy compliance before radical cystectomy (6)
Journal of Oncology Practice: First demonstration of improved survival for men withi high-risk prostate cancer treated in the MDC setting (3). Group Publishers Multi D Book (Dicker, et al by Demos Press) Shared Decision Making for Active Surveillance in the MDC setting poublished (5) Celebrating 25 years of SKCC Multidisciplinary GU Care
Gerald Andriole, MD, FACS
Professor of Urology
Multidisciplinary teams allow for optimal coordination among health professionals and clear communication with patients across a wide variety of genitourinary malignancies with the majority of cases involving prostate cancer.
Since 1996, more than 12,000 patients have benefitted from the care provided by our SKCC GU MDC care model. Even during the height of the pandemic, the GU MDC team rapidly pivoted to Jefferson’s robust telehealth infrastructure to continue cancer evaluations and care in a virtual setting. Over the years, the GU MDC team has also provided support for the annual Prostate Cancer Awareness screening program held each September.
The GU MDC team is appreciative of the support of Jefferson’s leadership provided by our Sidney Kimmel Cancer Center leadership and Thomas Jefferson University Hospital in particular. Please see the national and international recognition of our GU MDC by leaders in the field on page 6.
REFERENCES
1. Valicenti RK, Gomella LG, El-Gabry EA, et al. The multidisciplinary clinic approach to prostate cancer counseling and treatment. Semin Urol Oncol. 2000 Aug;18(3):188-91.
2. Lallas CD, Scotland K, Zhang M, et al, Clinical Influences in the Multidisciplinary Management of Small Renal Masses at a Tertiary Referral Center Oncology Practics Vol. 3, 468-474, November 2016.
3. Gomella LG, Lin J, Hoffman-Censits J, et al. Enhancing prostate cancer care through the multidisciplinary clinic approach: a 15-year experience. J Oncol Pract. 2010 Nov;6(6):e5-e10.
4. Giri VN, Gross L, Gomella LG, Hyatt C. How I Do It: Genetic counseling and genetic testing for inherited prostate cancer. Can J Urol. 2016 Apr;23(2):8247-53 5. Myers RE, Leader AE, Censits JH, et al Decision Support and Shared Decision Making About Active Surveillance Versus Active Treatment Among Men Diagnosed with LowRisk Prostate Cancer: a Pilot Study. J Cancer Educ. 2018 Feb;33(1):180-185. doi: 10.1007/s13187-016-1073-7.
6. Mark JR, Smentkowski K, Gomella LG et al, The Multidisciplinary Clinic Approach for Bladder Cancer Treatment in the Neoadjuvant Therapy Era (ASCO GU 2020, San Francisco, CA; manuscript in preparation).
To refer a patient to a Multidisciplinary Clinic at SKCC, schedule an appointment, or speak with a navigator, call 215-955-8516.
Multidisciplinary GU Cancer Center Sidney Kimmel Cancer Center Thomas Jefferson Univeresity
Current 2021 organizational structure of the Multidisciplinary GU Cancer Clinic of the NCI designated Sidney Kimmel Cancer Center.
WELL WISHES
Comments and well wishes from colleagues near and far on the 25th Anniversary of the Sidney Kimmel Cancer Center GU Multidisciplinary Clinic
“Dr. Gomella, over the past 25 years, your pioneering concept of a multidisciplinary approach to improve the care of patients with genitourinary cancer has been widely admired and served as a model across the U.S. and Europe. Congratulations!”
Patrick C. Walsh, MD University Distinguished Service Professor Emeritus, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD
“Warm congratulations to the Sidney Kimmel Cancer Center GU Clinic program on its 25th anniversary. Prof. Leonard Gomella and colleagues have been true visionaries, initiating and promoting the multidisciplinary cancer clinic in urologic oncology. This unit has been exemplary for us in Europe (Valdagni R, Eur J Cancer 2011), and has inspired us to create the prostate cancer networks based on the definitions for quality care in The Netherlands (www.anserprostaatcentrum.nl). The groups focus on genetic traits has also stimulated the field for progress in research and counselling patients. Please continue the valuable work!”
Prof C.H. Bangma MD, PhD Professor in Urology Director Anser Prostate Network Honorary Chair for Value Based Health Care in Urology Erasmus University Medical Center, Rotterdam, The Netherlands
“My congratulations to Drs. Gomella, Dicker and Kelly, along with the entire Sidney Kimmel Cancer Center GU Multidisciplinary Cancer Team, in achieving this significant milestone. Back in 2016, we recognized the importance of their work with the Dean’s Team Science Award, and their continuing contributions over the years have more than substantiated this confidence.”
Mark L. Tykocinski, MD Provost and Executive Vice President for Academic Affairs Thomas Jefferson University The Anthony F. & Gertrude M. DePalma Dean Sidney Kimmel Medical College Philadelphia, PA
The Sidney Kimmel Cancer Center pioneered the implementation and operation of the Multidisciplinary Genitourinary clinic and has served as a model for many to emulate. ...The improvements in patient care, as compared to traditional approaches, with this clinical model have been documented, published and replicated around the world. Congratulations on the first 25 years of outstanding work, and we look forward to you leading us into the next quarter century!
Michael S. Cookson, MD, MMHC, FACS Professor & Chair, Dept of Urology Donald D. Albers Chair in Urology University of Oklahoma Health Sciences Center & The Stephenson Cancer Center Chief Surgical Officer, OU Health’s Stephenson Cancer Center Past President, Society of Urologic Oncology Oklahoma City, OK
“Cancer Care today is dependent on a multidisciplinary approach, which for the past 25 years, has been the cornerstone of the Sidney Kimmel Cancer Center in Philadelphia. The Urology Department has had a prominent role at the Sidney Kimmel Center, and is wellknown based on the various presentations, publications, symposia and seminars that have been initiated from work done at this prestigious focus of high quality research, innovations and ideas. Congratulations to this unique center for helping to disseminate what is not only the present but the vision for the future of urologic cancer care."
Raju Thomas, MD, FACS, FRCS, MHA President, American Urologic Association Professor and Chair Department of Urology Tulane University School of Medicine New Orleans, LA
"As former Executive Vice President of Oncology Services at Jefferson Health and Director of the Sidney Kimmel Cancer Center, I had the opportunity to interact with the leadership of the GU Multidisciplinary Clinic team on a regular basis. Drs. Gomella, Kelly and Dicker's long-term dedication to this outstanding program has made it a useful model for others to follow. In my new role as CEO of the American Cancer Society, I have even greater appreciation of how this Multidisciplinary Clinic approach serves the needs of patients and their families and promotes the best cancer care available. Congratulations to all on your 25th anniversary."
Karen E. Knudsen, MBA PhD CEO, American Cancer Society and ACS CAN Philadelphia, PA
"I would like to extend my personal congratulations to the Sidney Kimmel Cancer Multi-Disciplinary clinic and its members for all that you have accomplished since your clinic's inception in 1996. With its 25 year history, it is notable that it is the longest running such clinic in any NCIdesignated Cancer Center. The list of the accomplishments of this clinic are numerous and important. It has become a role model for other such efforts nationwide and internationally. Congratulations on your 25th anniversary!"
Robert C. Flanigan. MD, FACS Professor of Urology Past President, American Urologic Association Loyola University Health System and Loyola’s Stritch School of Medicine Chicago, IL
“Professor Gomella is one of my heroes in Urology. I cannot think of many urologists who were able to achieve the same levels of perfection in patient management, mentoring young clinicians and researchers and being a wonderful individual to develop such a beneficial multidisciplinary program.”
Francesco Montorsi MD, FRCS (Hon) Professor and Chairman, Department of Urology, Editor Emeritus, European Urology Vita e Salute San Raffaele University, Milan, Italy
“Congratulations to Dr. Gomella and his group on their 25th anniversary of multidisciplinary urological cancer care. They are to be lauded for their advancements in genetics, chemotherapy and surgery. The multidisciplinary care interactions between urology, oncology and radiation therapy, have improved both survival and quality of life for all patients.”
Daniel P. Petrylak, MD Professor of Medicine and Urology Smilow Cancer Center Yale University School of Medicine New Haven, CT
"Thank you for including me in the 25 Year Anniversary acknowledgement of the GU Multidisciplinary Clinic program at the Sidney Kimmel Cancer Center. I am proud to say we were way ahead of our time, and we had the collective skills, collaborative spirit and insight to make multidisciplinary care happen."
Richard K. Valicenti, MD Professor and Chair Department of Radiation Oncology University of California, Davis Sacramento, CA “The SKCC GU Multidisciplinary Clinic has set the standard for delivering the highest quality comprehensive cancer care over the past 25 years, and thus serves as the benchmark for national comparison.”
Andrew Chapman, DO, FACP Interim Executive Vice President Oncology Services Interim Enterprise Director and Chief of Cancer Services, SKCC Professor, Medical Oncology Co-Director, Jefferson Senior Adult Oncology Center Philadelphia, PA
“Dr. Gomella and colleagues have developed the blueprint for multi-disciplinary excellence. They have developed and executed a framework where patients, trainees, researchers and fellow clinicians all benefit immensely. This should be implemented everywhere.”
Gerald Andriole, MD, FACS Professor of Urology Director of the Brady Urological institute, National Capital Region, Johns Hopkins University Washington, DC & Baltimore, MD
“I am proud to have been a small part of the initial multidisciplinary GU cancer clinic launched at Thomas Jefferson University in 1996. This was a novel concept when the clinic was conceived and launched in 1996. The success of the Thomas Jefferson’s/Sidney Kimmel Cancer Center Multidisciplinary Clinic is evident in that Multidisciplinary Cancer care has gone from a unique concept to incorporation into our AUA guidelines. At the University of Kentucky, our Markey Cancer Center Multidisciplinary Cancer clinic was modeled in the image of the Sidney Kimmel Cancer Center GU Multi-D clinic and has been successful as well. Congratulations to Dr. Gomella and the entire team at the Sidney Kimmel Cancer Center Multi-D clinic for their dedication and vision to a concept that has advanced Urologic Cancer Care across the US and beyond.”
Stephen E. Strup, MD, FACS James F. Glenn Professor & Chair Department of Urology University of Kentucky Lexington, KY
“For 25 years the multidisciplinary GU Oncology Clinic at TJU has epitomized three foundational collaborative principles— maximizing collective intelligence, inclusive collaboration, and open communication—for the benefit of patients. Bravo for setting a high standard and on a job well done!”
Eric A, Klein, MD Emeritus Andrew C. Novick Distinguished Professor and Chair, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
“Multidisciplinary care for genitourinary malignancies has evolved from cutting edge to standard of care. This is in large part due to pioneers such as Leonard Gomella and Rich Valicenti at the Sidney Kimmel Cancer Center who recognized the value in working together to develop protocols, streamline care and in doing so advancing treatment. Congratulations on 25 years of improving patient’s lives.”
Adam S. Kibel, M. Chief of Urology Brigham and Women's Hospital/ Dana-Farber Cancer Institute Elliott Carr Cutler Professor of Surgery Harvard Medical School, Boston MA
"The SKCC GU multi-disciplinary clinic is a major success story. Having managed over 12,000 GU cancer patients over a 25-year period is an enviable track record, second to none. Kudos to Dr. Gomella and the collaborative teams of urologists, medical oncologists and radiation oncologists in creating a role model for others to follow".
Inderbir S. Gill, MD Distinguished Professor Chairman, Catherine & Joseph Aresty Department of Urology Executive Director, USC Institute of Urology Shirley & Donald Skinner Chair in Urologic Cancer Surgery Associate Dean for Clinical Innovation Keck School of Medicine, USC Los Angeles, CA
“As a Jefferson Alumni, I am so proud to recognize Dr. Gomella and his Jeff Urologic Oncology Team for their pioneering and groundbreaking efforts to start a true multidisciplinary clinic for men with prostate cancer 25 years ago. In fact, our group used the JEFF model to initiate the first prostate multi-D clinic in the military health system at Walter Reed and the DoD Center for Prostate Disease Research (DoD-CPDR) also in the 1990’s. Later when I joined the Duke University group, we also built on the original JEFF and military experience. Prostate multi-D care is now routine, but 25 years ago it was a novel approach.”
Judd W. Moul, MD, FACS James H. Semans, MD Professor of Surgery and Anesthesiology Division of Urologic Surgery Duke Cancer Institute Durham, NC
“The Sidney Kimmel Cancer Center GU multidisciplinary clinic has set a benchmark for collaborative care and integrated practices nationally and internationally. Highly innovative at the time of its design and implementation, this clinic has meaningfully impacted patient care and facilitated important research for patients with urologic malignancies. Congratulations to the team for this milestone in a practice that has significantly advanced our field.”
Stephen A. Boorjian, MD, FACS Carl Rosen Professor in Urology Chair, Department of Urology Director, Urologic Oncology Fellowship Mayo Clinic, Rochester, MN
"The GU Multidisciplinary Clinic at the Sidney Kimmel Cancer Center has been visionary in bringing together focused and balanced expertise from numerous specialties across the medical profession with a singular goal...improving outcomes for patients. Congratulations on your first 25 years!"
Edward Schaeffer, MD, PhD Edmund Andrews Professor &Chair Department of Urology Northwestern University Chicago, IL
“I was pleased to learn that you have celebrated the first 25 years of service of the Sidney Kimmel Multidisciplinary Genitourinary Cancer Clinic. You are to be congratulated on your vision 25 years ago to establish this excellent model for prostate cancer care and then all genitourinary cancer as the model for others to emulate. In Melbourne, Australia we have adopted your model of care in our prostate cancer clinic.I did have the great privilege of visiting your Sidney Kimmel Cancer Center in 2019.
"I especially congratulate you on your foresight in establishing the men's genetic risk program incorporating testing and counselling for prostate cancer. After my visit to you, we established a prostate cancer genomics screening clinic in Melbourne modelled on the Sidney Kimmel pathway. I wish you well for the next 25 years, Dr. Gomella. I am sure this innovative program will continue to flourish under your guidance. Sincere good wishes to you all.”
Anthony Costello, AM, MD, FRACS, FRCSI, MBBS Professor Emeritus Urology Department Royal Melbourne Hospital Melbourne, Australia
“The first tumor marker in oncology (acid phosphatase), the first effective oral therapy for a cancer(estrogens), the most important tumor marker in oncology (PSA), and two Nobel prizes represent the progress in prostate cancer. During the last two decades, many new interventions and therapies were introduced. Multi-disciplinary care is now the standard. The SKCC GU Multidisciplinary clinic, launched in 1996, joins the above list of firsts by recognizing and actively promoting the value of a team approach. Congratulations to Dr. Gomella and his colleagues on being the leaders in this area.”
E. David Crawford, MD Professor of Urology Chairman, Prostate Conditions Education Council University of California San Diego San Diego, CA
“To the credit to the team at Jefferson, they were amongst the first to establish a GU Multidisciplinary Clinic in the country. They effectively set the standard which other institutions followed. The Sidney Kimmel Cancer Center GU Multidisciplinary Clinic was literally decades ahead of its time and helped changed the way we deliver GU cancer care.”
David F. Penson, MD, MPH Professor and Chair, Department of Urology Hamilton and Howd Chair in Urologic Oncology Vanderbilt University Medical Center Nashville, TN
Congratulations to the Sidney Kimmel Cancer Center Genitourinary Multidisciplinary Team for being a leader in patient care for the past 25 years! We look forward to your continued accomplishments.
James Eastham, MD Chief, Urology Service Department of Surgery Memorial Sloan Kettering Cancer Center New York, NY
