This study supports our belief that multidisciplinary communication improves outcomes and enrollment in clinical trials. Tumor boards represent one tool that can improve care for cancer patients, and the effect is difficult to measure.
—Kenneth L. Kehl, MD
A large, population-based, observational study suggests that participation in weekly tumor boards can improve outcomes in oncologic care. Specifically, oncologist participation in weekly tumor board meetings was associated with improved survival in patients with stage IV small cell lung cancer and stage IV colorectal cancers. Weekly tumor board participation was also associated with an increased likelihood of patient enrollment in clinical trials and increased the likelihood of guideline-based curative surgery for patients with early-stage non–small cell lung cancer (NSCLC).
“Prior single-center studies suggest that tumor boards often change treatment recommendations. These findings from a larger study are exploratory and will be the basis of future research. Patients with lung cancer and colorectal cancer may want to ask their doctors if their cases will be discussed by a tumor board that includes multidisciplinary experts,” said lead author Kenneth L. Kehl, MD, a fellow in cancer medicine at The University of Texas MD Anderson Cancer Center, Houston.
The study utilized data from the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS), with a total of 9,732 patients diagnosed with lung or colorectal cancer from 2003 to 2005. Of them, a cohort of 4,620 patients were included in this study, as well as 1,601 physicians who reported on their tumor board participation; of them, 1,198 were linked directly to the patients in the cohort. Physicians were asked how often they participated in tumor board meetings, whether the meetings were educational or helped in treatment-planning, whether they reviewed challenging cases only, and whether tumor board meetings focused on more than one cancer site.
Patients had a mean age of 68 years, 51% were male, 62% were married, and stage at diagnosis was evenly distributed between both types of cancers. Among physicians, 33% were medical oncologists, 15% were radiation oncologists, 37% were general surgeons, and 15% were subspecialty surgeons. Physicians treated a mean of eight lung cancer patients and eight colorectal cancer patients per month. Twenty-seven percent of physicians worked at a National Cancer Institute–designated cancer center.
Patterns of Participation
The study revealed different patterns of oncologist participation in multidisciplinary tumor boards. About 54% participated weekly, 26% monthly, 8% quarterly, 8% less than quarterly, and 4% said they never participated in tumor boards.
Among those who ever participated in a tumor board, 83% said their tumor board primarily served a pretreatment planning function, 92% said it included evaluation of treatment decisions, 59% reviewed only challenging cases, 87% reviewed multiple tumor sites, and 12% were for educational purposes only.
Among physicians, radiation oncologists were more likely to participate in tumor boards, while surgeons and surgery subspecialists were less likely to participate. Those who worked at a Veteran’s Administration/government facility were more likely to participate, whereas those in solo or group practices were less likely.
Tumor board participation in challenging cases only was associated with lower mortality rates, and participation in educational tumor boards was associated with higher mortality.
Note of Caution
Dr. Kehl cautioned that this was not a randomized trial, so one should not leap to the conclusion that tumor board participation directly improves survival. The study identifies associations rather than direct effects.
“This study supports our belief that multidisciplinary communication improves outcomes and enrollment in clinical trials. Tumor boards represent one tool that can improve care for cancer patients, and the effect is difficult to measure,” Dr. Kehl noted. ■
Disclosure: Dr. Kehl reported no potential conflicts of interest.
1. Kehl KL: Tumor boards among physicians caring for lung and colorectal cancer patients. Quality Care Symposium. Abstract 179. Presented October 17, 2014.