The impact of tumor board on breast cancer care: evidence from a systematic literature review and a meta-analysis

Abstract

BackgroundBreast cancer is the most common malignancy in women, with a complex clinical path that involves several professionals. A multidisciplinary approach is therefore essential and there is a growing emphasis on its application to breast cancer care. However, the effectiveness of breast cancer multidisciplinary care and the processes that contribute to its effectiveness have not yet been firmly determined. This study aims to evaluate the impact of MTBs on breast cancer care outcomes.MethodsA systematic literature review was carried out through Scopus, Web of Science and Pubmed databases. The search was restricted to articles assessing the impact of MTB implementation on breast cancer care, written in English and Italian language, published between 1995 and 2021.The quality of the included articles was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group from National Heart, Lung and Blood Institute Study Quality Assessment Tools. To combine not homogeneous results, when appropriate, meta-analysis was performed.ResultsFourteen studies, published between 2006 and 2021, were included in the review. From the quality assessment, seven studies were found to be of FAIR and seven of GOOD quality. The most analysed outcomes were: diagnosis, therapy and survival. Four out of four studies showed that with the implementation of the MTB there was a change in diagnosis, and seven out of seven studies reported changes in the treatment plan after MTB implementation. In terms of survival, results were not unanimous. A pooled analysis of three studies reporting results on the outcome “mortality” showed, in the fixed-effects model (p=0.43), a statistically significant 14% reduction of mortality relative risk for patients enrolled versus not enrolled in MTBs (pooled HR = 0.86; 95%CI: 0.81- 0.97). ConclusionsThis study shows that the implementation of the MTBs is a valuable approach to deliver appropriate and effective care to patients affected by breast cancer and to improve their outcomes. Further studies are needed to enrich the evidences available to date concerning especially the outcomes less investigated, but important to improve clinical care and care processes.