The impact of tumor board on cancer care: evidence from an umbrella review

Maria Lucia Specchia,Walter Ricciardi,Gianfranco Damiani,Danila Cappa,Emanuela Maria Frisicale,Elettra Carini,Andrea Barbara,Andrea Di Pilla

doi:10.1186/s12913-020-4930-3

Abstract

BackgroundTumor Boards (TBs) are Multidisciplinary Team (MDT) meetings in which different specialists work together closely sharing clinical decisions in cancer care. The composition is variable, depending on the type of tumor discussed. As an organizational tool, MDTs are thought to optimize patient outcomes and to improve care performance. The aim of the study was to perform an umbrella review summarizing the available evidence on the impact of TBs on healthcare outcomes and processes.MethodsPubmed and Web of Science databases were investigated along with a search through citations. The only study design included was systematic review. Only reviews published after 1997 concerning TBs and performed in hospital settings were considered. Two researchers synthetized the studies and assessed their quality through the AMSTAR2 tool.ResultsFive systematic reviews published between 2008 and 2017 were retrieved. One review was focused on gastrointestinal cancers and included 16 studies; another one was centered on lung cancer and included 16 studies; the remaining three studies considered a wide range of tumors and included 27, 37 and 51 studies each. The main characteristics about format and members and the definition of TBs were collected. The decisions taken during TBs led to changes in diagnosis (probability to receive a more accurate assessment and staging), treatment (usually more appropriate) and survival (not unanimous improvement shown). Other outcomes less highlighted were quality of life, satisfaction and waiting times.ConclusionsThe study showed that the multidisciplinary approach is the best way to deliver the complex care needed by cancer patients; however, it is a challenge that requires organizational and cultural changes and must be led by competent health managers who can improve teamwork within their organizations. Further studies are needed to reinforce existing literature concerning health outcomes. Evidence on the impact of TBs on clinical practices is still lacking for many aspects of cancer care. Further studies should aim to evaluate the impact on survival rates, quality of life and patient satisfaction. Regular studies should be carried out and new process indicators should be defined to assess the impact and the performance of TBs more consistently.

Highlights

Tumor Boards (TBs) are Multidisciplinary Team (MDT) meetings in which different specialists work together closely sharing clinical decisions in cancer care
MDT meetings are a fundamental part of a complex care path, during which MDTs gather to discuss on a series of patients in order to achieve a definite staging and formulate a shared treatment plan, in the light of the best available evidence for customized treatment options and appropriate followup
Search strategy A systematic research of reviews was conducted through PubMed and Web of Science databases using the following string: ((cancer OR neoplasm* OR tumour* OR tumor* OR malignanc*) AND (“cancer management” OR “tumor board*” OR “tumour board*” OR “cancer board*” OR “multidisciplinary team*” OR “multidisciplinary meeting*” OR “cancer MDT” OR “cancer care” OR “multidisciplinary conference*” OR “multidisciplinary clinic*” OR “patient care team*” OR “patient care planning”) AND (“clinical decisionmaking” OR “outcome and process assessment” OR “diagnosis change*” OR survival OR “guidelines adherence” OR morbidity OR mortality OR management))

Summary

Introduction

Tumor Boards (TBs) are Multidisciplinary Team (MDT) meetings in which different specialists work together closely sharing clinical decisions in cancer care. The multidisciplinary approach could be a great challenge and a useful platform for the coordination of care, and a tool to optimize decision-making and communication processes. It improves the healthcare system and its experience for both patients and professionals, concerning oncological diseases [1, 4, 5]

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