Multidisciplinary Tumor Board Meetings Research Articles

The Educational Impact and Clinical Role of Multidisciplinary Liver Tumor Board Meetings in an Academic Liver Transplant Center

The Educational Impact and Clinical Role of Multidisciplinary Liver Tumor Board Meetings in an Academic Liver Transplant Center

Tumor boards among physicians caring for lung and colorectal cancer patients.

179 Background: Multidisciplinary tumor board meetings are an important part of cancer care, but few data are available about their benefits. We assessed the association of tumor board participation and structure with patient outcomes. Methods: We surveyed a population and health system-based cohort of patients with lung or colorectal cancer diagnosed in 2003-05 (N=9732) and their physicians (N=1601). We asked physicians how often they participated in tumor boards and whether those meetings served a treatment planning function, evaluated prior treatment decisions, reviewed only challenging cases, reviewed >1 cancer site, and/or served only as teaching sessions. Using logistic and Cox regression, we assessed associations of tumor board participation and tumor board features with patient clinical trial enrollment, receipt of guideline-concordant care, patient-reported quality, and survival. We adjusted for patient demographic and clinical characteristics and physician traits, including specialty. In this exploratory analysis, P values were not adjusted for multiple comparisons. Results: Patients treated by the 54% of physicians participating in tumor boards weekly (vs. less often/never) were more likely to enroll in clinical trials (OR 1.6, 95% CI 1.1-2.2). Patients of physicians whose meetings reviewed >1 cancer site had lower likelihood of trial enrollment (P=0.04) and, among patients with stage I/II non-small cell lung cancer (NSCLC), of curative-intent surgery (P<0.001). Patients with stage I NSCLC, extensive-stage small cell lung cancer (SCLC), or stage IV colorectal cancer had lower mortality if treated by physicians participating in tumor boards weekly (vs. less often/never, P<0.05). Stage I NSCLC patients whose physicians’ tumor boards reviewed >1 cancer site had higher mortality (P=0.04), as did patients with SCLC whose physicians’ tumor boards served only as teaching sessions (P=0.004 for limited SCLC, <0.001 for extensive SCLC). Conclusions: Frequent physician tumor board engagement was associated with patient clinical trial participation and lower mortality for colorectal, small cell lung, and early non-small cell lung cancer, diseases that may benefit from coordinated treatment delivery among specialists.

Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis

Aggressive fibromatoses (desmoid tumours) may be locally aggressive, but do not metastasize. Although a conservative approach is advocated for most patients, pain and functional impairment are indications for active treatment. Tumour necrosis factor (TNF) α and melphalan-based isolated limb perfusion (TM-ILP) is a limb-saving treatment modality for soft tissue tumours. This study reports the results of TM-ILP treatment in patients with aggressive fibromatosis. Institutional databases of three European centres were searched. All patients who received TM-ILP treatment for aggressive fibromatosis between 1990 and 2012 were included. Before therapy, the patients were discussed at multidisciplinary tumour board meetings. Twenty-five patients received 28 TM-ILP treatments. The median age of patients was 28 (i.q.r. 19-34) years and median hospital stay was 8 (7-12) days. Median follow-up was 84 (34-114) months. A complete response was achieved after two TM-ILP treatments, and a partial response after 17 treatments in 16 patients. Stable disease was reported after eight treatments in seven patients, including a patient with stable disease after the first treatment and progression after the second TM-ILP. Toxicity was modest after most treatments; Wieberdink grade IV (extensive epidermolysis, and threatening or manifest compartment syndrome) was seen after two TM-ILP treatments. Systemic leakage was reported after one treatment, but did not lead to systemic toxicity. Functional outcome was good; 16 patients had no physical limitations, and six patients had some limitations but did not need medical aids. Amputation was prevented in all but three patients. TNF-α-based ILP is effective in patients with aggressive fibromatosis.

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.

Implementing an innovation to improve coordination of care in breast cancer.

52 Background: Underuse of adjuvant breast cancer treatments delivered by different specialists may be worsened by fragmented care and improved by effective coordination. To improve care coordination and adjuvant treatment delivery, we assessed the challenges to and feasibility of implementing a web-based Tracking and Feedback (T&F) innovation in hospitals serving predominantly minority breast cancer patients. Methods: We interviewed 67 key informants [Clinical (n = 39), Administrative (n = 14), Clerical (n = 11), Other (IT, Social Work) (n = 3)] from 8 inner-city hospitals to better understand how organizational characteristics might impact coordination of care and implementation of the T & F innovation. We used the constant comparative method of qualitative data analysis and standard techniques to code the data. Results: We found considerable variability across hospitals’ abilities to coordinate and track care. All sites have multi-disciplinary Tumor Board meetings and active Quality Improvement departments. Yet, in several sites, specialty care remains siloed, quality improvement efforts focus on inpatient care and communications systems across outpatient specialties are poor. All hospitals have electronic medical records but they are not integrated and are unable to track requested referrals. Many physicians rely on follow-up appointments to ascertain treatment receipt but sites vary in their ability to address “no-shows.” Several rely on staff to manually identify and follow up “no-shows,” but many of these staff are overwhelmed with ever increasing tasks and responsibilities. While quality was important, several interviewees felt they were bucking an inflexible system and devised ways to work around the obstacles. Perceived successful coordination factors included strong clinical leadership, designated accountabilities, and flexibility of staff. Conclusions: As care integration is encouraged by federal law, specialty care silos and rigid communication systems still pose barriers to change. Our results suggest that a web-based T&F innovation must be tailored to individual hospital characteristics, and flexible to permit modification of care processes at the organization level. Clinical trial information: NCT01544374.

Error Rates in Breast Imaging Reports: Comparison of Automatic Speech Recognition and Dictation Transcription

The purpose of this study was to compare the error rates in breast imaging reports generated with automated speech recognition (ASR) technology as opposed to conventional dictation transcription. Breast imaging reports reviewed from January 2009 to April 2010 during multidisciplinary tumor board meetings at two hospitals were scrutinized for minor and major errors. Of 615 reports obtained, 308 were generated with ASR and 307 with conventional dictation transcription. At least one major error was found in 23% of ASR reports, as opposed to 4% of conventional dictation transcription reports (p < 0.01). Major errors were more common in breast MRI reports (35% of ASR and 7% of conventional reports), the lowest error rates occurring in reports of interventional procedures (13% of ASR and 4% of conventional reports) and mammography reports (15% of ASR and no conventional reports) (p < 0.01). The error rates did not differ substantially between reports generated by staff radiologists and trainees or between reports generated by speakers who spoke English as their first language and those whose native language was not English. After adjustment for academic rank, native language, and imaging modality, reports generated with ASR were 8 times as likely as conventional dictation transcription reports to contain major errors (p < 0.01). Reports generated with ASR are associated with higher error rates than reports generated with conventional dictation transcription. The imaging modality used is a predictor of the occurrence of reporting errors. Conversely, native language and academic rank of the speaker do not have a significant influence on error rate.

Is There a Role for Clinical Practice Guidelines in Multidisciplinary Tumor Board Meetings? A Descriptive Study of Knowledge Transfer Between Research and Practice

The aim of this study was to characterize practice patterns and decision-making processes of healthcare providers attending weekly neuro-oncology tumor board meetings, and to assess their familiarity with clinical practice guidelines (CPGs) in neuro-oncology. Members of the Neuro-Oncology Tumor Team at two tertiary cancer centers completed a web-based questionnaire assessing characteristics of weekly tumor board meetings and perceptions of CPGs. Twenty-three (66%) tumor team members responded. Diagnostic imaging results and interpretation, medical, surgical, and/or radiation treatment planning, and pathology results and interpretation were the most commonly identified aspects of patient care discussed at tumor board meetings, and almost all respondents indicated that these meetings were "very beneficial" to their own practice. When deciding on a treatment plan, respondents rely most on the clinical expertise of colleagues, medical literature, personal experience, active clinical trial protocols, and published CPGs. Opinions of the local CPGs varied considerably, and while 56% of respondents supported regular discussion of them during meetings, only 32% indicated that they were routinely reviewed. Updating the literature more frequently, implementing a formal grading system for the evidence, and incorporating clinical care pathways were the most frequently cited methods to improve the CPGs. Tumor board meetings are beneficial to the treatment planning process for neuro-oncology patients.