"A rising tide lifts all boats": establishing a multidisciplinary genomic tumor board for breast cancer patients with advanced disease.

Michelle L Mcgowan,Paula Silverman,Patricia A Marshall,Roselle S Ponsaran,Lyndsay N Harris

doi:10.1186/s12920-016-0234-1

Abstract

BackgroundResearch suggests that multidisciplinary genomic tumor boards (MGTB) can inform cancer patient care, though little is known about factors influencing how MGTBs interpret genomic test results, make recommendations, and perceive the utility of this approach. This study’s objective was to observe, describe, and assess the establishment of the Breast Multidisciplinary Genomic Tumor Board, the first MGTB focused on interpreting genomic test results for breast cancer patients with advanced disease.MethodsWe conducted a qualitative case study involving participant observation at monthly MGTB meetings from October 2013 through November 2014 and interviews with 12 MGTB members. We analyzed social dynamics and interactions within the MGTB regarding interpretation of genomic findings and participants’ views on effectiveness of the MGTB in using genomics to inform patient care.ResultsTwenty-two physicians, physician-scientists, basic scientists, bioethicists, and allied care professionals comprised the MGTB. The MGTB reviewed FoundationOne™ results for 40 metastatic breast cancer patients. Based on findings, the board mostly recommended referring patients to clinical trials (34) and medical genetics (15), and Food and Drug Administration-approved (FDA) breast cancer therapies (13). Though multidisciplinary, recommendations were driven by medical oncologists. Interviewees described providing more precise care recommendations and professional development as advantages and the limited actionability of genomic test results as a challenge for the MGTB.ConclusionsFindings suggest both feasibility and desirability of pooling professional expertise in genomically-guided breast cancer care and challenges to institutionalizing a Breast MGTB, specifically in promoting interdisciplinary contributions and managing limited actionability of genomic test results for patients with advanced disease.

Highlights

Research suggests that multidisciplinary genomic tumor boards (MGTB) can inform cancer patient care, though little is known about factors influencing how MGTBs interpret genomic test results, make recommendations, and perceive the utility of this approach
We report on a qualitative study to observe, describe, and assess the establishment of the Breast Multidisciplinary Genomic Tumor Board, the first MGTB focused on interpreting genomic test results for breast cancer patients with advanced disease
The MGTB was comprised of 26 individuals representing medical, surgical, and radiation oncology, pathology, genetics, epidemiology, biostatistics, bioinformatics, clinical chemistry, pharmacology, nursing, bioethics, patient advocacy, and patient coordination

Summary

Introduction

Research suggests that multidisciplinary genomic tumor boards (MGTB) can inform cancer patient care, though little is known about factors influencing how MGTBs interpret genomic test results, make recommendations, and perceive the utility of this approach. Research suggests that multidisciplinary cancer care teams can improve patients’ therapy planning, pain control, and medication adherence, though findings supporting their effectiveness in impacting patient survival and the costs of care are limited [16,17,18]. This may be due in part to discordance between recommendations and patient values and lack of follow up on tumor board recommendations [19, 20]. Studies suggest that multidisciplinary tumor boards and the use of standardized templates in tumor board conferences can improve oncology patient outcomes based on proxy measures such as the adherence to standards of care and national guidelines for treatment [21, 22]

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