In the face of any challenge needing problem-solving, more often than not we realize two (or more) heads are better than one. Having another sight of eyes to take in and digest the scenario and work together towards a solution can make all the difference for a particularly challenging situation.
When diagnosing and treating cancer, having more than one specialist looking at a case can have the same effect, especially for cancer patients with a more rare or complex case. Most hospitals and clinics have at least one cancer tumor board that allows specialists in different areas to collaborate on these more unique cases and discuss possible treatment plans. These tumor boards not only stand to benefit the patients, but can also have an overall positive effect for the doctors attending.
What Is a Tumor Board?
Cancer, regardless of type, is never really a black-and-white situation. Determining the right cancer treatment for an individual case takes a lot of consideration, especially given the number of treatments and clinical trials available today. Having another opinion from someone in another discipline, like a surgical oncologist or pathologist, can help narrow down the options or open the doors to potentially more effective personalized treatments, such as which chemotherapy drug to use.
Tumor boards have been a part of cancer care for decades and are standard at most hospitals, though many doctors agree that there’s still lots of room for improvement. These boards are a multidisciplinary team effort to review and discuss individual patient’s current condition and treatment options in depth. Most often, these boards will consist of surgical, medical and radiation oncologists, along with radiologists and pathologists. If needed, other disciplines may be pulled in as well, like pain management. While the specific functions may vary among different cancer institutes, tumor boards prime objectives include:
- Educating healthcare providers
- Assisting in treatment planning and management decisions for patients
- Creating more collaboration and appreciation among different specialties
Cases with an advanced tumor, unusual pathology or unexpected complications from treatment are prime candidates for a tumor board discussion, though doctors can certainly use these meetings to discuss any cancer cases they want. Many institutions have at least one tumor board that discusses a variety of cancer types, though increasingly hospitals and cancer centers have multiple boards for specific cancers, such as breast cancer, prostate cancer or pancreatic cancer.
Boards may meet on a regular basis, even as often as weekly meetings, to personally review medical records and discuss patients at theirs or other local clinics. Other medical centers may approach tumor boards on an as-needed basis, and will gather to discuss more complex cases when they arise. With more technological advancements, there have also been more and more national and international virtual tumor boards popping up, where doctors can use video or conference call meetings to discuss cases in many locations in real-time.
In general, these meetings consist of doctors explaining the medical history and circumstances of their patient’s condition. This includes all radiological, surgical and pathological findings, as well as any social and medical issues that may impact their treatment. The group will then discuss current studies and best practices, and work together to determine treatment recommendations.
Potential Patient Benefits
Undoubtedly, patients have a lot to gain from their case being reviewed in a multidisciplinary setting. Firstly, a meeting of multiple specialists at once can expedite the process. If patients are considering getting a second opinion on their cancer diagnosis or treatment, it can take time to schedule appointments with different oncologists or specialists, and thus possibly delay care. In these settings, patients won’t have to wait to hear more options and opinions. After a tumor board meeting, their primary physician will generally relay the new information and possible treatment options to the patient to then make a decision.
A big benefit from these boards is the potential for patients to receive more personalized treatment options and see a better chance of survival. Specialists in different areas, like surgical oncology or radiation oncology, may know of emerging treatments or research studies the patient could benefit from that their primary doctor may not be aware of. These meetings can lead to a patient having more, better treatment options.
A 2014 study in The ASCO Post, found oncologists’ participation in tumor boards may have positively benefited patient outcomes more often than not. The study surveyed over 4,000 patients with advanced stage lung cancer or colorectal cancer and included 1,600 oncologists. Of the oncologists, 96% had participated in tumor boards and 54% of them do so weekly.
The results showed patients experienced better overall survival when their healthcare team participated on boards more frequently. Patients whose medical oncologist rarely if ever participated or only attended board meetings with a teaching focus experienced slightly worse survival. These patients also showed a 60% more likely chance of participating in a clinical trial than those whose oncologists never or rarely attended tumor board reviews. Though the researchers explained the study can’t be understood as conclusively showing tumor board participation directly results in better survival, the research at the very least suggests more doctors working together on an individual case can often improve a patient’s odds.
Benefits for Oncologists
Tumor board reviews also have several benefits for those who attend. Most notably, one of the pillars of tumor boards is education. In fact, some tumor boards meet specifically for teaching opportunities.
Over many meetings, doctors of these various specialties will have a great opportunity to learn about more diverse and newer treatment options, especially those that may be outside of their own specialty. Often, residents or attendees in the hospital may also attend these meetings for additional training and education. These gatherings helps advance the group’s knowledge overall, which in turn benefits the care the medical center provides.
These meetings can also enhance the doctors’ relationships with one another. This level of collaboration can foster greater levels of respect for one another’s work and opinions. Tumor boards may also help create a more collaborative environment even outside of the specific review meetings.
Many believe collaboration and better data sharing is truly the key to curing this deadly disease one day. Though not every case necessarily needs a board review to determine the best treatment, having a multidisciplinary review can provide better care overall, from properly diagnosing a difficult case to the treatment plan and coordinating where a patient receives treatment. Tumor boards have the potential set up everyone for better success. Hopefully in the future, more physicians and medical centers will take advantage of these meetings, and patient care will continue to improve.