Multidisciplinary Tumor Board Discussion Research Articles

Liver Metastasectomy for Metastatic Breast Cancer Patients: A Single Institution Retrospective Analysis.

The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients who had undergone an LM after a multidisciplinary Tumor Board discussion at the Hepatobiliary Surgery Unit of Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS in Rome, between January 1994 and December 2019 was conducted. The primary endpoint was overall survival (OS) after a MBC-LM; the secondary endpoint was the disease-free interval (DFI) after surgery. Forty-nine MBC patients underwent LM, but clinical data were only available for 22 patients. After a median follow-up of 71 months, median OS and DFI were 67 months (95% CI 45–103) and 15 months (95% CI 11–46), respectively. At univariate analysis, the presence of a negative resection margin (R0) was the only factor that statistically significantly influenced OS (78 months versus 16 months; HR 0.083, p < 0.0001) and DFI (16 months versus 5 months; HR 0.17, p = 0.0058). A LM for MBC might represent a therapeutic option for selected patients. The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option.

Synchronous dual malignancies: Carcinoma larynx and hepatocellular carcinoma

Synchronous cancers are defined as two or more primary cancers diagnosed in the same patient at the same time or within 6 months of diagnosis of each other. The diagnosis of multiple primary malignancies is not uncommon. A 70-year-old male reported to our hospital with chief complaints of change in voice and difficulty in swallowing solid food for 2 months accompanied anorexia since 20 days. The patient revealed occasional consumption of alcohol for 3 years and bidi smoking for 50 years (10 bidis per day). The patient was conscious, cooperative, and well oriented to time, place and person with an Eastern Cooperative Oncology Group of 0. On physical examination, the oral cavity and oropharynx were unremarkable. Direct laryngoscopy revealed ulceroproliferative growth in right-sided vallecula, right-sided aryepiglottic fold, right side arytenoid and pyriform sinus, and right vocal cord. Biopsy from this growth turned out to be poorly differentiated squamous cell carcinoma. Computed tomography (CT) scan of the neck and thorax revealed 1.5 cm × 2.6 cm heterogeneously contrast enhancing lesion involving right aryepiglottic fold, pyriform fossa, posterior hypopharyngeal wall, and posterior aspect of both false vocal cords. Few subcentimeter lymph nodes were noted in right side Level II. The CT scan also showed some mass lesion abnormality in the upper section of liver images which could not be properly made out. Hence, triple-phase CT scan of the liver was done which to a great surprise showed 7.7 cm × 6.5 cm × 5.5 cm lesion in segment V and VIII, it showed enhancement on arterial phase, became prominent on portovenous phase and a delayed phase washout. Similar lesion measuring 4.4 cm × 4.1 cm was seen in segment VIII of liver; which was diagnosed radiologically as a multicentric hepatocellular carcinoma. Serum alpha fetoprotein was markedly elevated to a value of 28,600 ng/mL. A multidisciplinary tumor board discussion was done, and an intense literature review was done, and a decision was taken keeping in mind the overall performance score of the patient to commence with a high palliative radiotherapy for laryngeal cancer to a dose of 45 Gray in 15 fractions at a dose of 3 Gray per fraction and tablet tamoxifen at a dose of 60 mg/day till the end of radiation followed by switching over to tablet sorafenib. The patient ultimately developed uremia due to liver failure and died. The patient survived for a period of 3 months from the time of diagnosis of malignancy. Such cases need a meticulous approach for the diagnosis as well as treatment approaches. Keeping in mind the general condition of the patient and available therapeutic options, a patient-based specific approach could be developed.

Do Multidisciplinary Tumor Board Discussions Correlate With Increase in 5-Year Survival? A Meta-Analysis Study.

Due to the complex nature of cancer cases, it is imperative that the involved healthcare providers coordinate the patients care plan in union to reach the best possible outcome in the smoothest and fastest manner. This is what multidisciplinary tumor board (MTB) meetings strive to achieve. Conducting regular MTB meetings requires significant investment of time and finances. It is thus vital to assess the empirical benefits of such practice. A meta-analysis was conducted to evaluate the literature regarding the impact of MTB meetings on patient 5-year survival. Relevant studies were identified by searching Ovid MEDLINE and Embase databases from January 1995 to July 2019. Studies were included if they assessed 5-year survival in cases discussed in MTB meetings and used a comparison group and/or a pretest and posttest design. Five articles met the study's inclusion criteria. Quality of studies was affected by selection bias and the use of historic cohorts. The results showed significantly improved 5-year survival in the MTB group compared with the non-MTB groups (odds ratio for 5-year death rate of 0.59, CI 0.45-0.78, p < 0.001). This meta-analysis showed that cancer MTB meetings have a significant impact on patients' 5-year survival. This could be because of several reasons, such as less time to treatment initiation, better adherence to guidelines, higher numbers of investigational imaging, lesser surgical complications, and recurrence rates. Future prospective studies are needed to further delineate reasons for improvement of outcome to enhance the benefits of this approach.

A snapshot on radiotherapy for head and neck cancer patients during the COVID-19 pandemic: a survey of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) head and neck working group.

ObjectivesThe objective of the paper was to assess real-life experience in the management of head and neck cancer (HNC) patients during the COVID-19 pandemic in radiotherapy departments and to evaluate the variability in terms of adherence to American Society of Radiation Oncology (ASTRO) and European Society for Radiotherapy and Oncology (ESTRO) recommendations.Materials and methodsIn May 2020, an anonymous 30-question online survey, comparing acute phase of outbreak and pre-COVID-19 period, was conducted. Two sections exploited changes in general management of HNC patients and different HNC primary tumors, addressing specific statements from ASTRO ESTRO consensus statement as well.ResultsEighty-eight questionnaires were included in the demographic/clinical workflow analysis, and 64 were analyzed for treatment management. Forty-eight percent of radiotherapy departments became part of oncologic hubs. First consultations reduced, and patients were addressed to other centers in 33.8 and 18.3% of cases, respectively. Telematic consultations were used in 50% of follow-up visits and 73.9% of multidisciplinary tumor board discussions. There were no practical changes in the management of patients affected by different primitive HNCs. Hypofractionation was not favored over conventional schedules.ConclusionsCompared to pre-COVID era, the clinical workflow was highly re-organized, whereas there were no consistent changes in RT indications and schedules.Electronic supplementary materialThe online version of this article (10.1007/s11547-020-01296-7) contains supplementary material, which is available to authorized users.

Engaging patients on tumor boards: A multi-stakeholder perspective study.

e19243 Background: Patient and family-centered care (PFCC) is grounded in the concepts of dignity and respect, information sharing, and active participation and collaboration in their health care. Efforts to engage patients and family members as part of the healthcare team as part of robust multidisciplinary breast cancer care (MBCC), including in multidisciplinary tumor boards, is an extension of PFCC for breast cancer care. Our team explored multi-stakeholder perspectives of engaging patients as partners on a virtual multidisciplinary tumor board (MTB) using an mHealth application. Methods: We conducted a prospective cohort study employing semi-structured interviews and focus group methodology to explore stakeholder (patients with Stage 0-III breast cancer, family members/caregivers, clinicians, and tumor board staff) perspectives of engaging patients in a virtual MTB. Interviews and focus groups were audiotaped, transcribed, and analyzed using concurrent content analysis to identify common themes. Recruitment continued until saturation of themes was achieved. Results: We conducted 22 interviews and 5 focus groups with 49 participants. Patients and family members reported discomfort with idea of engaging in MTB discussions about their cancer. Disease burden, limited understanding of medical terminology, and not wanting to be a part of the early discussions about their disease (e.g., being overwhelmed, need to trust clinician’s advice) were commonly reported. Clinicians and staff also reported concerns about patient engagement in MTB. Clinicians reported that it may change the candor of the discussions at MTB and obfuscate the problems/issues if they needed to modify their language to accommodate patients’ sensitivities. Clinicians and staff were also concerned about patient’s perception of discordance within the MTB clinician members and how to explain this uncertainty to patients. Staff concerns centered around the use of medical terminology which may create anxiety and result in patient misunderstanding. Conclusions: Clinicians, staff, patients and family members were overwhelmingly concerned about adding patients to the MTB. Engaging patients in the frank and candid early treatment planning discussions may need further evaluation in a clinical environment and among different patient cohorts.

Impact of multidisciplinary tumor board discussion on palliation of patients with esophageal or gastro-esophageal junction cancer: a population-based study

Background: The Dutch guidelines for esophageal and gastro-esophageal junction (GEJ) cancer recommend discussion of patients by a multidisciplinary tumor board (MDT). Despite this recommendation, one previous study in the Netherlands suggested that therapeutic guidance was missing for palliative care of patients with esophageal cancer. The aim of the current study was therefore to assess the impact of an MDT discussion on initial palliative treatment and outcome of patients with esophageal or GEJ cancer.Material and methods: The population-based Netherlands Cancer Registry was used to identify patients treated for esophageal or GEJ cancer with palliative intent between 2010 and 2017 in 7 hospitals. We compared patients discussed by the MDT with patients not discussed by the MDT in a multivariate analysis. Primary outcome was type of initial palliative treatment. Secondary outcome was overall survival.Results: A total of 389/948 (41%) patients with esophageal or GEJ cancer were discussed by the MDT before initial palliative treatment. MDT discussion compared to non-MDT discussion was associated with more patients treated with palliative intent external beam radiotherapy (38% vs. 21%, OR 2.7 [95% CI 1.8–3.9]) and systemic therapy (30% vs. 23%, OR 1.6 [95% CI 1.0–2.5]), and fewer patients treated with stent placement (4% vs. 12%, OR 0.3 [95% CI 0.1–0.6]) and best supportive care alone (12% vs. 33%, OR 0.2 [95% CI 0.1–0.3]). MDT discussion was also associated with improved survival (169 days vs. 107 days, HR 1.3 [95% CI 1.1–1.6]).Conclusion: Our study shows that MDT discussion of patients with esophageal or GEJ cancer resulted in more patients treated with initial palliative radiotherapy and chemotherapy compared with patients not discussed by the MDT. Moreover, MDT discussion may have a positive effect on survival, highlighting the importance of MDT meetings at all stages of treatment.

Pre-diagnosis Multidisciplinary Tumor Board and Time to Staging in Lung Cancer: The Case Western MetroHealth Experience.

IntroductionNational guidelines support the discussion of cancer patients by multidisciplinary tumor boards (MTB). We researched whether early pre-diagnosis multidisciplinary tumor board discussions are associated with shorter times to staging in lung cancer.MethodsWe reviewed our institution’s lung cancer and MTB registries to retrospectively study if an early discussion at pre-diagnostic MTB (pd-MTB) influenced the timeliness of diagnostic evaluation. Over 14 months, 161 consecutive patients with a diagnosis of lung cancer were included. Fifty-five patients were presented at pd-MTB while 106 (controls) patients were not. The primary outcome was the difference in the time interval from suspicious imaging (Ix) to completion of staging (Sx). Outcomes were adjusted for key confounders with a multiple regression analysis.ResultsFor stages I, II, and III lung cancer, where time to therapy matters, early discussion of patients with nodules suspicious for malignancy at pd-MTB was associated with no time delays when compared to patients who were not discussed in pd-MTB. The mean time intervals for imaging to staging (with standard deviations) are 65 days in controls (sd = 42.67) and 75 days (sd = 58.27) in tumor board cases (p=0.39). Adjusting for confounders with a multiple regression analysis among all stages revealed a similar lack of difference in time intervals to diagnosis, staging, and therapy.ConclusionOur stage I-III lung cancer cases (pd-MTB) completed staging in a timely manner, similar to controls (no pd-MTB). The severity of illness at presentation and the availability of diagnostic services and others likely influence the results. Our manuscript shares important numerical data on timelines during cancer diagnosis and treatment. Using this data, prospective registries examining the process workflow may help standardize cancer quality goals and maximize referrals from primary-care/specialty providers. The key findings in our study create a paradigm for future studies to create and achieve “door-to-balloon” time targets for lung cancer care (akin to cardiac care) across different styles of tumor boards.

Introducing Multidisciplinary Oncology Management to the Medical Student

Despite the fact that a large portion of medical students pursue training in a cancer-related discipline, oncology is emphasized to a disproportionately lesser extent than are other disciplines in medical school. Medical students have wide gaps in their oncology-specific knowledge, and undergraduate medical education fails to address the multidisciplinary nature of oncology. To address these shortcomings and improve medical students’ understanding of the multidisciplinary nature of oncology, we have instituted a clinical oncology elective for medical students: an optional, 2-day session held after classes and promoted by student interest groups. Day 1 comprised a series of short faculty lectures beginning with the concepts of and rationale for staging, an approach to breaking bad news, guideline-based management, and multidisciplinary tumor board discussion. Three multidisciplinary tumor boards were simulated on the second day, run by attending surgeons, medical oncologists, and radiation oncologists with expertise in the cancer of interest, using real patient examples. Ultimately, the clinical oncology elective shows medical students how the oncology care team works together to care for cancer patients.

Multidisciplinary Cancer Management of Colorectal Cancer in Tikur Anbessa Specialized Hospital, Ethiopia.

PURPOSEMultidisciplinary cancer care is currently considered worldwide as standard for the management of patients with cancer. It improves patient diagnostic and staging accuracy and provides patients the benefit of having physicians of various specialties participating in their treatment plan. The purpose of this study was to describe the profile of patients discussed in the Tikur Anbessa Multidisciplinary Tumor Board (MTB) and the potential benefits brought by multidisciplinary care.METHODSThe study involved the retrospective assessment of all patient cases presented to the Tikur Anbessa Hospital colorectal cancers MTB between March 2016 and November 2017. The data were collected from the MTB medical summary documents and were analyzed using SPSS version 20 (SPSS, Chicago, IL).RESULTSOf 147 patients with colorectal cancer, 96 (65%) were men. The median age at presentation was 46 years (range, 17-78 years). The predominant cancer was rectal (n = 101; 69%), followed by colon (n = 24; 16%). Of these, 68 (45%) and 22 (15%) had stage III and IV disease, respectively, on presentation to the MTB. The oncology department presented the majority of the patients for discussion. Most patients had undergone surgery before the MTB discussion but had no proper preoperative clinical staging information. The majority of patients with rectal cancer treated before the MTB discussion had undergone surgery upfront; however, most of the patients who were treatment naive before MTB received neoadjuvant chemoradiotherapy before surgery.CONCLUSIONDecisions made by tumor boards are more likely to conform to evidence-based guidelines than are those made by individual clinicians. Therefore, early referral of patients to MTB before any treatment should be encouraged. Finally, other hospitals in Ethiopia should take a lesson from the Tikur Anbessa Hospital colorectal cancers MTB and adopt multidisciplinary cancer management.

Tumor control with palliative external beam radiation therapy (EBRT) in advanced and unresectable osteosarcoma (OS) progressing after standard treatment.

e22508 Background: Advanced OS still represents an unmet medical need. Chemotherapy and targeted therapies have only limited activity in this disease. Moreover, OS is considered a radioresistant tumor at doses conventionally achieved by EBRT. We retrospectively evaluated the impact of palliative EBRT in patients (pts) with advanced OS. Methods: Main inclusion criteria: confirmed histological diagnosis of OS; EBRT for advanced/metastatic disease deemed unresectable after multidisciplinary tumor board discussion; ECOG performance status ≤3, age ≥18 years at RT start; progressive disease at site of irradiation with symptoms (e.g., pain or neurological deficit) or involving critical structures (e.g., superior vena cava compression). Endpoints: progression-free survival (PFS), PFS for RT-treated lesions (RT-PFS), best response with RT, overall survival. All survival endpoints were computed from RT start. We calculated the equivalent total dose in 2 Gy fractions (EQD2). Results: 23 pts, 15 males, median age at diagnosis 33 (17-82), median age at RT start 36 (20-83) were included. All pts had grade 3-4 OS (12 osteoblastic; 6 chondroblastic; 5 other), 7 were metastatic at diagnosis. At time of RT, median metastatic sites were 2 (1-5), 15 pts were symptomatic (11 pain, 4 neurological deficit) and were mainly heavily pretreated [median previous chemotherapies 2 (1-5), median previous surgery 1 (0-2)]. Overall, 45 lesions underwent EBRT. Median EBRT dose per lesion was 33 Gy (IQR 25 - 46.5) with a median dose per fraction of 3 Gy (IQR 3-7.5). Calculated median EQD2 was 50 Gy (IQR 36 - 88). Median PFS, RT-PFS, and overall survival were 5 (95%CI 2-9), 11 (5-15), and 12 months (8-16), respectively. Compared to systemic progression, median progression delay of irradiated lesions was 6 months (95%CI 2 - 12). In 40 lesions evaluable for dimensional response, we observed tumor shrinkage &gt; 30% in 7 lesions, stability in 24, and progression in 9. Conclusions: EBRT might have a role in the treatment of advanced OS. In consideration of the limited activity of medical treatments, EBRT might help in disease control in the advanced setting, delaying progression especially at critical sites.

Minimally Invasive Pelvic Exenteration for Gynecologic Malignancies: A Multi-Institutional Case Series and Review of the Literature

To assess the feasibility and efficacy of minimally invasive pelvic exenteration (MIPE) in a multi-institutional Italian case series of women with gynecologic cancer and a review of the literature. Retrospective cohort study (Canadian Task Force classification II-2). Three Italian university/teaching hospitals: "Agostino Gemelli" Foundation University Hospital in Rome, "ARNAS Civico Di Cristina Benfratelli" Hospital in Palermo, and "Maggiore della Carità" Hospital in Novara. We reviewed all consecutive cases with gynecologic malignancies in this multi-institutional setting recorded between March 2014 and June 2017. Women with primary or central recurrent/persistent gynecologic cancer considered suitable for exenterative surgery after multidisciplinary tumor board discussion were included. Clinicopathological, perioperative, and survival data were retrieved from the institutional electronic database (STAR center). All patients underwent total or anterior MIPE with a laparoscopic or robotic approach. Twenty-three patients underwent MIPE during the study period, including 12 (52.1%) by a laparoscopic approach and 11 (47.9%) by a robotic approach. All but 1 woman underwent MIPE for recurrent disease. The overall median operative time was 540 minutes (range, 310-720 minutes) with laparoscopy, slightly longer than with the robotic approach (p = .04). Median estimated blood loss was 400 mL (range, 200-600 mL). R0 resection was achieved in 17 of 23 patients (73.9%). There were no perioperative deaths. Early major postoperative complications occurred in 2 patients (8.7%). The median duration of hospitalization was 10 days (range, 6-33 days). With a median follow-up of 15 months, 11 patients (47.8%) developed recurrence. The median disease-free survival was 11 months (range, 5-18 months). To date, 155 MIPEs for gynecologic cancers have been reported in the literature. Among these, 12.6% had major postoperative complications, and overall postoperative mortality was 0.6%. MIPE is a feasible procedure with low rate of intraoperative and postoperative complications. Careful patient selection is crucial to balance perioperative risks and potential survival benefits and to achieve complete tumor resection.

GUROPA survey: genito-urinary radiation oncology prescription attitudes.

To investigate the role of Radiation Oncology in the management of genito-urinary (GU) cancer excluding prostate and penile cancer. The questionnaire was focused on the evaluation of the degree of involvement of radiation oncologists in the work-up of bladder, renal cell carcinoma and testicular cancer (TC). Eighty-eight radiation oncologists completed the survey. The majority (85.4%) of participating radiation oncologists were senior consultants (> 5years of experience). Sixty-four (73.6%) carried out a multidisciplinary tumor board discussion of GU cases, while 23 (26.4%) did not. Seventy-five percent of responders reported that, every year, visited < 50 GU patients (pts), 18.1% visited 50-100 pts and 6.9% visited > 100 pts. Bladder cancer, curative radiotherapy (RT) as part of trimodality approach was claimed to be adopted in less than 10 cases per year. Regarding renal cell carcinoma (RCC) patients, primary tumor directed RT was adopted only in 8 cases (9.4%) in at least 10 pts per year. Palliative RT was more frequent in RCC (48.2%) in over than 10 pts per year. In case of TC, the prescription of RT was limited (< 10 patients per year) due to the low incidence of disease and recent shift to surveillance as a first option in stage I seminoma. Our survey showed that radiation oncologists are rarely involved in the decision making strategy of GU cancer, despite many clinical trials support RT use. These patients probably deserve a more uniform approach based on updated, detailed and evidence-based recommendations.

4:12 PM Abstract No. 269 Modern multidisciplinary management of hepatocellular carcinoma: deviation from BCLC guidelines does not alter survival

The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely used hepatocellular carcinoma (HCC) guideline. However, the BCLC system is criticized for its limited applicability in many clinical scenarios. In this study, we compared treatment recommendations from our multidisciplinary team to those recommended by the BCLC stage for patients designated BCLC stage 0 through stage D. With IRB approval, we included all new diagnoses of HCC discussed from 2010 to 2013 at our multidisciplinary tumor board, yielding 349 patients. The criteria for BCLC status at presentation were recorded. Tumor board recommendations for treatment, as well as BCLC recommendations were compared. Kaplan–Meier survival analyses were performed from the date of the first treatment, censored to curative treatment, to determine survival based on BCLC stage. The log-rank test was used to compare survival rates, with a P<0.05 considered significant. Of the 349 treatment-naïve patients 22 patients were BCLC 0, 153 were BCLC A, 31 were BCLC B, 97 were BCLC C, and 46 were BCLC D. Following multidisciplinary tumor board discussion, 79.9% (n = 279) received treatment recommendations discordant from BCLC recommendations. Intra-arterial therapy (chemoembolization or radioembolization) was used in 257 (73.6%) patients, discordant from BCLC recommendations. There was no significant difference in survival between patients who received BCLC treatment recommendations and those who did not (median survival 23.5 mos vs 24.2 mos, respectively, p = 0.21). Additionally, when substratified by BCLC stage, there were no significant differences in survival between those who followed BCLC treatment recommendations, and those who did not (p = 0.12). Determining HCC treatment requires a multidisciplinary approach. In this analysis of treatment naïve HCC, deviation from BCLC recommendations yielded no significant difference in overall survival, even when substratified by BCLC stage. As part of individualization of patient care, primary treatments often deviate from BCLC recommendations due to unique clinical scenarios not captured by BCLC. This analysis supports the concepts of individualized patient care.

Ninety-Day Mortality After Video-Assisted Thoracoscopic Lobectomy: Incidence and Risk Factors

We evaluated the incidence and risk factors of 90-day mortality rate after video-assisted thoracoscopic (VATS) lobectomy. Retrospective analysis on 733 VATS lobectomies or segmentectomies (January 2012 to February 2016), including 66 operations converted to open operation. Several patient-related and surgical variables were tested to verify their association with 90-day mortality using univariable and logistic regression analyses. A score was assigned to each variable in the final model by proportionally weighting the regression odds ratios (ORs) and assigning 1 point to the smallest one. A total score was generated for each patient by adding the individual points. The patients were finally grouped into classes of risk. In-hospital/30-day mortality rate was 1.9% (14patients). Additionally, 4 patients died after discharge between 30 and 90 days. Total 90-day mortality rate was 2.5% (18 patients). Regression analysis showed that factors significantly associated with 90-day mortality were male sex (OR 12, p= 0.001), carbon monoxide lung diffusion capacity (Dlco) less than 60% (OR 4.8, p=0.001), and operative time longer than 150 minutes (OR 4.2, p= 0.03). A score was developed assigning 1 point to the variables Dlco and operative time and 3 points to the variable male sex. The total score ranged from 0 (155 patients) to 5 points (32 patients). Patients were grouped into five risk classes showing an incremental 90-day mortality rate (class A, 0; class B, 0.38%; class C, 0.93%; class D, 5.65%; class E, 18.75%, p < 0.0001). Our results represent important information to be shared with the patients during surgical counseling. It can also assist multidisciplinary tumor board discussion about treatment selection.

Validation of Team Performance Assessment of Multidisciplinary Tumor Boards

We construct validated the instrument to evaluate assessor learning curves and the feasibility and interrater reliability of MTB-MODe for assessing the decision making process using video recorded multidisciplinary tumor board meetings. Multidisciplinary tumor boards are becoming standard practice for managing cancer internationally but no standards have been agreed on to assess the efficacy of such teams. The MTB-MODe tool assesses the process of multidisciplinary tumor board decision making by standardized observation (1to 5 anchored scales) of the quality of information presented at the multidisciplinary tumor board as well as board member contributions to the case review. We assessed 683 multidisciplinary tumor board case discussions using MTB-MODe in a multiphase study, including 332 cases (9 urology boards) by 1 urologist invivo and 224 cases (6 urology boards) by 2 urologists invivo. The instrument was refined and subsequently used to rate 127 video recorded case discussions (5 tumor types) by a total of 8 multidisciplinary tumor boards. Good interrater reliability was achieved invivo and at the video recorded multidisciplinary tumor board meetings (ICC ≥0.70). MTB-MODe scores were higher in cases that resulted in a decision than in cases in which no decision was made (mean ± SD 2.54 ± 0.47 vs 2.02 ± 0.65, p ≤0.001). A standardized method to assess the quality of multidisciplinary tumor board discussions can enhance the quality of cancer care and the ability of the boards to self-evaluate performance, thus, promoting good practice. Video recordings offer a feasible, reliable method of assessing how multidisciplinary tumor boards work.