“A rising tide lifts all boats”: establishing a multidisciplinary genomic tumor board for breast cancer patients with advanced disease

Abstract

Background: Research suggests that multidisciplinary genomic tumor boards (MGTB) can inform cancer patient care, though little is known about factors influencing how MGTBs interpret genomic test results, make recommendations, and perceive the utility of this approach. This study's objective was to observe, describe, and assess the establishment of the Breast Multidisciplinary Genomic Tumor Board, the first MGTB focused on interpreting genomic test results for breast cancer patients with advanced disease. Methods: We conducted a qualitative case study involving participant observation at monthly MGTB meetings from October 2013 through November 2014 and interviews with 12 MGTB members. We analyzed social dynamics and interactions within the MGTB regarding interpretation of genomic findings and participants' views on effectiveness of the MGTB in using genomics to inform patient care. Results: Twenty-two physicians, physician-scientists, basic scientists, bioethicists, and allied care professionals comprised the MGTB. The MGTB reviewed FoundationOne™ results for 40 metastatic breast cancer patients. Based on findings, the board mostly recommended referring patients to clinical trials (34) and medical genetics (15), and Food and Drug Administration-approved (FDA) breast cancer therapies (13). Though multidisciplinary, recommendations were driven by medical oncologists. Interviewees described providing more precise care recommendations and professional development as advantages and the limited actionability of genomic test results as a challenge for the MGTB. Conclusions: Findings suggest both feasibility and desirability of pooling professional expertise in genomically-guided breast cancer care and challenges to institutionalizing a Breast MGTB, specifically in promoting interdisciplinary contributions and managing limited actionability of genomic test results for patients with advanced disease.

Physician Experiences and Understanding of Genomic Sequencing in Oncology

“…Of note, all clinicians who referred a patient to this sequencing study were invited to attend a Precision Medicine Tumor Board, consisting of a multidisciplinary team of oncologists, molecular and clinical geneticists, genetic counselors, bioinformaticians, pathologists, and bioethicists (Everett et al 2014). Other centers have also begun to develop similar precision medicine-focused tumor boards to specifically review tumor testing results (Gunderson et al 2016; McGowan et al 2016; Schwaederle et al 2014). These types of multidisciplinary conferences may present another opportunity for clinicians to increase their education about tumor testing and increase direct interactions between basic scientists and clinicians, which could aid in improved communication and alignment in the perceived goals and outcomes of tumor testing.…”

Implementing a clinical cutting-edge and decision-making activity: an ethnographic teamwork approach to a molecular tumorboard

“…These changes in work practices were typical of a "learning organization", and reflected the ability to account for each situation, thereby improving organizational effectiveness. Paradoxically, the MTB members who participated in our study, like those involved in other MTBs in the literature, advocated a global standardization of responses and procedures at all levels [7,8,29,32], highlighting a tension between procedure stabilization and learning dynamics. Edmonson's framework showed us, that at an organizational level, procedures can be stabilized without limiting practice flexibility [30].…”

“…Our literature review showed that MTBs were diverse, ranging from small advisory boards providing treatment recommendations, to boards incorporated into large precision oncology-based clinical trials; all differed in composition, expert categories, genomic areas, bioinformatics techniques and workflows [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Genomic expertise in action: molecular tumour boards and decision‐making in precision oncology

“…Our criticism of the notion of trading zones also applies, mutatis mutandis , to contributions that have analysed MTBs in terms of a ‘pooling [of] professional expertise’ (McGowan et al . : 6). By merely focusing on the presence of different experts (albeit acknowledging the fact that new, nonclinical specialists have joined the fray), and even when emphasising ‘transdisciplinary engagement’ rather than mere multidisciplinarily (Knepper et al .…”