Abstract PS7-22: Multidisciplinary Tumor Board in Breast Cancer: Results from a large international survey involving 71 countries

Abstract

Abstract Introduction: Multidisciplinary tumor boards (MTB) offer patients (pts) access to multidisciplinary care and may lead to more efficient, cost-effective and evidence-based treatments and better outcomes. Data regarding the implementation and functioning of breast cancer (BC) MTB worldwide and according to countries’ income are lacking. Methods: We developed a survey, which was disseminated to healthcare professionals working in BC through the use of social networks and emails (accessible from 15 May to 3 July 2020). Countries’ income classification was defined according to the World Bank Atlas method. Results: We obtained 675 responses from 71 countries (40% Western Europe, 14% Eastern Europe, 13% Latin America, 13% Asia, 11% Oceania, 5% North America, 3% Africa; 71% high income, 28% middle income, 1% low income countries). More than half of the respondents were medical oncologists (55%), followed by surgical oncologists (12%), clinical oncologists (11%) and radiation oncologists (7%). Over 60% were between 30-49 years of age and 55% had >10 years of medical practice. MTBs from academic institutions (43%), dedicated cancer centers (30%), public (19%) and private (18%) institutions were reported. Overall, 11% of respondents do not have regular MTBs in their institution, with discrepancies among regions: 34% of respondents from Asia, 18% from Africa, 17% from Eastern Europe, 14% from Latin America, 3% from Western Europe, 2.6% from Oceania and none from North America. This corresponds to 43% of respondents from low income, 22% from middle income and 5.6% from high income countries. Among these, 42% have their patients informally discussed between departments, 23% within a single department and the decision is taken only by the attending physician in 31% of the cases. Eighty-nine percent of respondents (N=602) have regular MTBs, of which 69% are dedicated to BC; 71% discuss all stage I-IV BC cases before any treatment decision, whereas 18% only present new BC cases, before starting any form of treatment and 11% discuss only early BC cases. Above 80% have >4 disciplines represented (18% have 1-3, 44% 4-6, 37% 7-9 and 13% >10). The most represented discipline is medical oncology (98%), followed by surgical oncology (94%), radiation oncology (90%), pathology (87%) and radiology (80%), among others. A nurse is present in 49% of MTB, a psychologist/psychiatrist in 19%, a social worker in 11% and the doctor in charge of the patient in 25%. Pts are not present in 80% of MTB in high income countries, in 44% in middle income and in 29% in low income. Half of respondents reported that it is not mandatory for the treating doctor to implement the decision of the MTB. For 72%, the decision of the MTB is implemented in >75% of the cases, but only 24% have a quality control to check this. When asked about the results of an effective BC MTB, respondents agreed that it resulted in improved clinical decision making (95%), more coordinated patient care (86%), evidence-based treatment decisions (89%), shorter time to tests/treatments (60%) and improved survival (50%). During the COVID19 pandemic, 5% of all MTB were cancelled, 50% switched to virtual meetings, 16% maintained physical MTB with adjustments (social distance/personal protective equipment). Only 7% believe that all MTB will remain virtual, 40% think that MTB will return to their original physical version and 53% that there will be an alternating scheme. Conclusions: The vast majority of participants reported having regular MTBs in their institution, with a high rate of uptake of MTB recommendations. Differences in the implementation of MTB according to the countries’ level of income can be observed and highlights the need to scale-up MTB coverage around the world, especially in low/middle income countries. The COVID19 pandemic led to a high adoption of virtual MTB, which may have long-term effects. Citation Format: Rita Saúde-Conde, Sofia Ferreira, Mariana Brandão, Gil Morgan, Evandro de Azambuja. Multidisciplinary Tumor Board in Breast Cancer: Results from a large international survey involving 71 countries [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-22.