Expert Point of View: Nancy L. Keating, MD, MPH

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By Nancy L. Keating, MD, MPH

In this large study examining care for patients with a variety of tumor types in the Veterans Health Administration (VA), we found no clear association of tumor boards with better quality of care or outcomes. It is unclear if our findings can be generalized outside of the VA, although in other work, we have shown that the quality of care for patients with cancer in this setting is similar to or better than that with fee-for-service Medicare. Most likely, any impact of tumor boards on quality depends on the tumor board participants and the role of the tumor board.

In addition, it is possible that tumor boards may provide limited additional benefit when performance is assessed using generally accepted measures of guideline-recommended care, as was the case in our study, but they may be particularly helpful for patients for whom treatment decisions are more complex. Nevertheless, it remains true that very little is known about the structure and function of tumor boards and the outcomes associated with their use, despite the large number of person hours that are required for tumor boards to function. ■

Disclosure: Dr. Keating reported no potential conflicts of interest.

Dr. Keating is Associate Professor of Medicine and of Health Care Policy at Harvard Medical School and Associate Physician at Brigham and Women’s Hospital, Boston.

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