Author:
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
Abstract
IntroductionAdvanced 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).MethodsTwenty-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.ResultsRecommended 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 ad hoc targeted therapies.DiscussionWhile 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.