Gut scan: ‘Do tumor panels improve care?’

When oncologists and other doctors meet to discuss a difficult cancer case, hopefully the patient will do better.

But this is not necessarily a certainty for the Multidisciplinary Board of Oncology.

Data evaluating oncology boards—in particular, the extent to which these conversations between specialists improve patient outcomes—remain mixed.

Some studies, for example, have found a survival benefit, while others have not. One analysis even revealed that an irregular tumor slab was associated with worse patient survival.

But survival outcomes may not dictate the true impact a tumor panel can have on patients or caregivers. Research indicates that these multidisciplinary groups often perform important functions that cannot be measured in the examination or patient chart.

Arif Kamal, MD, chief patient officer of the American Cancer Society and an oncologist at Duke Cancer Institute in Durham, North Carolina, said that in addition to discussing treatment, oncology boards should “make sure the logistics of treatment are in line with life.” He explained that a good oncology panel can build patient confidence, improve coordination of care, and identify factors that may hinder patient adherence to the plan.

The evidence is mixed

Multidisciplinary oncology boards have become an essential component of cancer care in many institutions.

Rather than individuals making decisions in a bubble, the group dynamics in the oncology panel allow clinicians from various fields to influence patient care. The goal is to make better and more coherent treatment decisions.

“I consider it the Justice League — each specialty has its own expertise in looking at what’s best for the patient,” said Shearwood McClelland III, MD, a radiation oncologist at University Hospitals Seidman Cancer Center in Cleveland, Ohio. “My role on the Board of Oncology is to bring the benefits and the risks radiotherapy. A surgical oncologist will consider surgical indications.”

Oncology boards typically work like this: A group of physicians, which can include medical, surgical, and radiological oncology along with pathology, patient mobility, and financial counseling, meets weekly to discuss a few challenging cases. The doctor in charge of the patient’s treatment—often an oncologist, surgeon, or radiation oncologist—refers the case to the group. Oncology review boards can be small, with only a few specialists, or larger affairs with dozens of attendees.

“We tend to limit patients for whom the pathology is somewhat unusual, and the diagnostic imaging somewhat unusual, or patients for whom the medical or surgical oncologist has questions about management,” Douglas said, which typically represents about 10 % to 15% of patients. Blainey, MD, A breast cancer Specialist at Stanford Women’s Cancer Center in Palo Alto, California.

Although research is limited, evidence for the impact of oncology boards on important clinical outcomes, such as patient survival, is mixed.

This is largely because these effects are difficult to study in a controlled, critical way, said Sherry Ren, a surgical oncologist at Stanford University with a focus on gastrointestinal cancers.

one study, published in BMJIt was found that after providing multidisciplinary oncology care in hospitals in Scotland, breast cancer deaths were 18% lower among patients who received the team-based intervention. Another study is over That these teams “enhance the multidisciplinary management of patients with cancer,” provide feedback and sometimes lead to changes in diagnosis and treatment plans.

However, one Analytics Little association was observed between multidisciplinary tumor boards and measures of quality or survival.

Some of the inconsistencies may be due to how well the tumor panel is working. A 2019 analysis, for example, indicated that the 5-year survival rate was 15.6% higher among cases in the well-structured multidisciplinary tumor groups, but about 20% lower in the unstructured groups compared with the no tumor plate.

“It should come as no surprise that improved process performance or quality measures of outcomes are not expected by the presence of team meetings,” Blainey wrote in a letter. editorial. “Executing the plan is how we get results no matter how brilliant the plan, the talent of the team, or the difficulty of the task.”

Benefits outside of clinical decision making

Despite mixed data on patient outcomes, oncology boards can offer value outside the clinical decision-making process.

In a recent study published in gamma tumorsWren and colleagues reveal many of these functions: building trust, nurturing continuing education, as well as promoting understanding among professionals.

Patients may feel better with the treatment plan knowing that a panel of experts reviewed their condition and came to a consensus, Ren explained.

Another major benefit of the Oncology Board: education. Cancer care has become highly specialized over the past few decades. New recommendations and indications change frequently for some types of cancer. It’s too much for any doctor to keep track of.

“The cognitive burden of a general oncologist or even a specialist oncologist is very high,” Kamal said. “New indications for a drug or evidence of change of practice are emerging all the time,” Kamal said.

Oncology boards rely on specialists who are up to date with the latest developments in their fields, and then bring that expertise back to the group so that everyone stays informed.

Oncology boards also provide new avenues for interdisciplinary collaboration, and even camaraderie. That could mean increased physician satisfaction and reduced fatigue, according to Ren and colleagues.

“It often feels like you’re not making a decision out of the blue,” said one of Wren’s study participants. “Like checking the gut.” Another participant commented, “We learn from each other and work together on research.”

In addition to discussing treatment, Kamal said, a good oncology committee will look at what will harm patient adherence to the treatment plan and what will help. This means identifying stressors not related to illness, potential for financial toxicity, and caregiver concerns.

“If a patient comes to see us from two hours away, is there a place where he can get injections locally so that he doesn’t have to miss a work day?” Kamal said.

Get the most out of oncology boards

But people may not always interact with each other when bringing together experts from different disciplines.

Disagreements may arise about the best course of treatment and this can hinder decision making.

“When the plaque of tumors breaks loose, it’s usually because people are overheated and feel strongly about their situation,” said James Worzer, MD, a radiation oncologist at AtlantiCare Radiation Oncology, NJ.

For example, a radiologist may want to perform a specific test for a patient, but a surgical oncologist may feel that it is unnecessary. “This can take a long time back and forth,” he explained. “Sometimes the discussion cannot be resolved within the allotted time, and this key person needs to continue the issues.”

Disagreements are normal, especially when there is no one right answer to caring for a person. Sometimes, according to Wren’s study, treating physicians bring a case of cancer to a board of oncology to adjudicate a difference of opinion about a patient’s treatment.

Most clinicians agree that the kind of delaying decision-making controversy described above is rare. This is especially true when participants understand that recommendations are made unanimously rather than unanimously, Blaney explained.

The Oncology Board’s consensus statement can contain multiple recommendations. For example, the Oncology Board may conclude that Mastectomy It is the best course of treatment for a patient with breast cancer but note that many surgeons may feel that lumpectomy It is also a reasonable option. Blainey said the attending physician could then return these recommendations to the patient for discussion.

Aside from potential controversies, time and attendance are two other major challenges to the success of the Oncology Board.

Coordinating schedules can be difficult among clinicians with busy schedules, and if not all specialties are in place, the benefits of an oncology panel really are lost, McClelland explained.

In addition, physicians are not usually compensated for the time they spend at oncology board meetings. “In a fee-for-service environment, non-payment creates unprecedented tension around tumor slabs. Taking an hour during the day could mean the doctor sees three or four fewer patients,” Kamal added.

Zoom, Microsoft Teams, and other video conferencing platforms can now alleviate some of the issues with scheduling an oncology panel and attendance.

But to keep time management on track, someone must commit to keeping the meeting organized and making decisions ahead. This includes making sure there aren’t too many cases on display and that the mix of cases isn’t too complex, Werzer said.

Oncology boards can provide value to both providers and patients, and improve patient care when participants are open and engaged.

Kamal said the “spirit of curiosity” is critical to the High-Performance Oncology Board. “It’s important to remember that you are there to learn from your peers.”

Plus, “a dose of humility can help,” McClelland said.

Lindsey Kunkel Niebuhr is a science journalist living in Haddon, New Jersey.

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