Bracarda Sergio, Iacovelli Roberto, Baldazzi Valentina, Zucali Paolo Andrea, Gernone Angela, Conti Giario Natale, Pappagallo Giovanni, Brunelli Matteo, Bruzzi Paolo, Fiorini Edoardo, Magenta Laura, Diomede Francesco, Mereta Federico, D'Aria Irma, Magliano Danilo, Liberatori Monica, Cantù Daniela, Croce Davide, Eandi Simone, Colombo Giorgio Lorenzo, Ferrante Fulvio, Salè Emanuela Omodeo, Marinozzi Andrea, Lenzi Daniele, Remiddi Francesca, Remiddi Stefano
President of Italian Society of Uro-Oncology, Department of Medical Oncology, Santa Maria Hospital, Terni, Italy.
Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Front Oncol. 2023 Jul 28;13:1186103. doi: 10.3389/fonc.2023.1186103. eCollection 2023.
Advanced urothelial carcinoma remains aggressive and very hard to cure, while new treatments will pose a challenge for clinicians and healthcare funding policymakers alike. The U-CHANGE Project aimed to redesign the current model of care for advanced urothelial carcinoma patients to identify limitations ("as is" scenario) and recommend future actions ("to be" scenario).
Twenty-three subject-matter experts, divided into three groups, analyzed the two scenarios as part of a multidimensional consensus process, developing statements for specific domains of the disease, and a simplified Delphi methodology was used to establish consensus among the experts.
Recommended actions included increasing awareness of the disease, increased training of healthcare professionals, improvement of screening strategies and care pathways, increased support for patients and caregivers and relevant recommendations from molecular tumor boards when comprehensive genomic profiling has to be provided for appropriate patient selection to targeted therapies.
While the innovative new targeted agents have the potential to significantly alter the clinical approach to this highly aggressive disease, the U-CHANGE Project experience shows that the use of these new agents will require a radical shift in the entire model of care, implementing sustainable changes which anticipate the benefits of future treatments, capable of targeting the right patient with the right agent at different stages of the disease.
晚期尿路上皮癌仍然具有侵袭性且极难治愈，而新的治疗方法将给临床医生和医疗保健资金政策制定者带来挑战。U-CHANGE项目旨在重新设计当前晚期尿路上皮癌患者的护理模式，以识别局限性（“现状”情景）并推荐未来行动（“未来”情景）。
23名主题专家分为三组，作为多维度共识过程的一部分分析这两种情景，针对该疾病的特定领域制定声明，并使用简化的德尔菲方法在专家之间达成共识。
推荐的行动包括提高对该疾病的认识、增加对医疗保健专业人员的培训、改进筛查策略和护理途径、增加对患者和护理人员的支持，以及在必须提供全面基因组分析以选择合适患者进行靶向治疗时，分子肿瘤委员会的相关建议。
虽然创新的新型靶向药物有可能显著改变对这种高度侵袭性疾病的临床治疗方法，但U-CHANGE项目的经验表明，这些新型药物的使用将需要整个护理模式发生根本性转变，实施可持续变革，预见未来治疗的益处，能够在疾病的不同阶段为合适的患者匹配合适的药物。
