Practice and Impact of Multidisciplinary Tumor Boards on Patient Management: A Prospective Study

Abstract

PurposeMultidisciplinary tumor boards (MTBs) have become commonplace. The use, attendance, and function of MTBs need continued assessment and improvement.MethodsWe prospectively recorded and assessed all cases presented at MTBs between October 2013 and December 2014. Data were collected before and during each MTB. Data were analyzed using SPSS for Windows version 23 (SPSS, Chicago, IL).ResultsFive hundred three cases were presented: 234 cases (46%) at GI cancer MTBs, 149 cases (29.6%) at breast cancer MTBs, 69 cases (13.7%) at thoracic/head and neck cancer MTBs, and 51 cases (10.7%) at neuro-oncology MTBs. A total of 86.7% of MTB cases were presented to make plans for management. Plans for upfront management were made in 67% of the breast cancer cases, 63% of GI cases, 59% of thoracic/head and neck cases, and 49% of neuro-oncology cases. Three hundred ninety-four cases (78.3%) were presented by medical oncologists, whereas only 74 cases (14.7%) were presented by surgeons, and 10 cases (2%) were presented by radiation oncologists. The majority of MTBs, with the exception of the neurosurgery MTBs, were led by medical oncologists. Surgeons presented the least number of cases but attended the most, and their contributions to discussions and decision making were essential.ConclusionMTBs enhance the multidisciplinary management of patients with cancer. Upfront multidisciplinary decision making should be considered as an indicator of benefit from MTBs, in addition to changes in management plans made at MTBs. Increasing the contributions of surgeons to MTBs should include bringing more of their own cases for discussion.

Molecular profiling for precision cancer therapies

“…They examine each patient's clinical, pathologic, and molecular information, review the literature and available resources, carry out discussions to reach a consensus if possible, and make treatment suggestions [89]. Previous studies have shown that interdisciplinary tumor boards can result in significant changes in treatment decisions [90][91][92][93]. The impact of MTB on outcomes has not yet been studied indepth, but they can help to identify patients for clinical trials, educate participants, facilitate collaboration, and ensure that providers across multiple locations are testing and treating patients in a uniform and consistent manner, based on clinical practice guidelines and best available evidence.…”

The Value of a Second Opinion for Breast Cancer Patients Referred to a National Cancer Institute (NCI)-Designated Cancer Center with a Multidisciplinary Breast Tumor Board

“…Another more recent study by Charara et al 10 in 2017 focused more on the decision-making process involved in an MTB. However, of 503 cases presented, only 12 resulted in a change in radiology findings, and only 6 cases had a change in pathology.…”

“…Although this study did not focus on second opinions, it was noted in the paper that half of the patients in each of the radiology and pathology change groups had second opinions. 10 …”

Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project

“…Part of this inter-centre variability could be due to legitimate inter-centre differences in the organizational models of the MTBs. Although a few studies have questioned whether it is really necessary to present all patients to a MTB [15], we believe-as recent studies have shown [16]-that this is important because it may alter the diagnosis or treatment plan in a substantial proportion (20-50%) of cases. The main concerns about the value of the MTP appear to be the structure and composition of the board itself and the thoroughness of decision-making and follow up.…”