Bladder cancer care is complex, time-sensitive, and often nuanced. To overcome these challenges, Duke Cancer Institute (DCI) launched a dedicated multidisciplinary bladder cancer clinic designed to deliver coordinated, expert care across the entire disease continuum. “This team-based model brings together urologic oncology specialists, patients, and caregivers in one setting to support collaborative care planning and optimize outcomes,” says Christopher Hoimes, DO, urologic medical oncologist.

The bladder cancer clinic is fully integrated with a real-time multidisciplinary approach. Rather than relying on asynchronous consultations that can span weeks, patients are evaluated collaboratively starting from their initial consultation. Urologic oncologists, medical oncologists, radiation oncologists, surgeons, and other interdisciplinary team members meet with the patient to establish a diagnosis, confirm staging, and develop a shared treatment plan that accelerates care.

Hoimes notes, “Bladder cancer, particularly muscle-invasive disease, presents distinct diagnostic and staging challenges. Accurate staging depends on assessing tumor invasion through a membrane only millimeters thick, making precision essential.” DCI’s urologic oncology specialists review cystoscopy findings and pathology alongside imaging studies such as MRI and ultrasound, and when appropriate, molecular tools to achieve more confident staging and tailored treatment recommendations.

Depending on stage and patient goals, care may include systemic chemotherapy, immunotherapy, radiation, surgery, or bladder-sparing approaches, and often a combination of these. “Timing is crucial; delays can compromise outcomes,” says Hoimes. Duke’s model ensures that decisions about perioperative or periconsolidative therapy, neoadjuvant or adjuvant treatment, and radiation sequencing are made collectively and efficiently, delivering the right care to each patient at the right time.

“We have the capacity to treat patients with complex bladder cancer with a streamlined pathway to deliver care in an efficient, comprehensive, and coordinated way,” says Ankeet M. Shah, MD, urologic oncologist. “The team works together in the same physical clinic, so patients benefit from multiple appointments in one day and in one convenient location, as well as expedited treatment plans.” 

The clinic is also a destination for second opinions and complex case consultations, which often benefit from multidisciplinary discussions to decipher subtle nuances in staging, surgical approach, or selection of non-surgical therapies. DCI’s urologic oncology team regularly advises patients on innovative options that might not be available at other cancer centers, including organ-preserving strategies, advanced surgical techniques, innovative radiation therapy approaches, and clinical trials.

Paul Koffer, MD, radiation oncologist, adds, “Multi-disciplinary care is critical in the successful management of bladder cancer. There are so many new and evolving options in the treatment for muscle invasive bladder cancer; having the option to meet with an integrated team of expert surgeons, medical oncologists, and radiation oncologists who can work together to tailor a personalized plan for each patient can make such a difference in cancer outcomes and quality of life.”

DCI has a robust clinical trials portfolio for all stages of urothelial cancer, including intravesical therapies, systemic intravenous treatments, innovative surgical techniques, and advanced radiation approaches for bladder preservation. Several transformative immunotherapy strategies, now FDA-approved, were developed at Duke. 

“Our team will discuss research opportunities early with patients, often at the first or second visit, to ensure eligible patients have access to cutting-edge therapies that may improve their survival, remission rates, and treatment tolerability,” says Hoimes. “We’re eager to advance the field by leading the discovery of new treatments for patients,” he adds.

Integral to this model is a highly engaged nursing and care coordination team. Dedicated oncology nurses, ostomy specialists, nutritionists, and coordinators mirror physician collaboration and provide seamless support for patients throughout treatment. “We’re blessed to have a dedicated urothelial cancer team that is deeply committed to patients and delivering the best and latest care,” Hoimes adds.

Recognizing that bladder cancer is relatively uncommon and that many patients travel long distances for expert care, the clinic offers practical flexibility. While initial visits are in person, follow-up appointments can often be conducted virtually. In-person appointments can also be arranged for morning or afternoon visits to accommodate patients’ travel. Hoimes concludes, “We partner with patients’ local oncology teams and communicate frequently to ensure ongoing care is accessible and centered around patients’ unique needs.”