Multidisciplinary Tumor Board Meetings Research Articles

Development and initial evaluation of a visualization tool for multidisciplinary treatment discussion of patients with pancreatic cancer.

585 Background: Pancreatic cancer is the third leading cause of cancer death in the United States; it is a complex disease requiring coordinated patient care. Multidisciplinary tumor boards (MTB) are today's gold standard in pancreatic cancer but are frequently criticized for being time-intensive and inefficient. To address this issue, Cancer Collective and Hive Networks have developed a novel patient-information visualization tool designed to improve the communication and efficiency of multidisciplinary tumor board meetings. This pilot study investigated the patient-information visualization tool's usability, efficiency, and feasibility in pancreatic cancer tumor board meetings. Methods: A prospective multi-center pilot study was conducted at Northwell Health (a comprehensive community cancer program [NCCCP] in the Northeastern United States) and the University of California San Diego (an NCI-designated comprehensive cancer center in [NCCC] in the Southwestern United States. The feasibility of the tool was assessed by measuring the percentage of MTB cases discussed that used the patient-information visualization tool. The usability and efficiency of the tool were assessed via Likert scale questions. Acceptable usability and effectiveness were defined as a 70% score or higher. Additionally, MTB participants were queried for input on design improvements for future iterations and expected future directions of tool use. Results: The patient-information visualization tool was rolled out on 07/22/2022 at the NCCP and NCCC. From 07/22/2022-05/31/2023, 170 (92%) MTB cases were reviewed at the NCCP. From 07/22/2022-05/31/2023, 74 cases (100%) of MTB cases were reviewed using the patient-information visualization tool at the NCCP. The NCCP (n=9) mean scores for usability and efficiency were 4.31 (86%) and 4.17 (83%) respectively. The NCCC (n=6) mean scores for usability and efficiency were 4.04 (81%) and 3.96 (79%) respectively. Qualitative feedback, reported on survey open-ended questions, included suggested enhancements to improve the tool’s usability, such as leveraging data automation to reduce data entry burden, improving the user interface for ease of data visualization, and adding additional data elements (e.g., specific procedure and appointment details) to improve decision-making utility. Conclusions: Implementing the novel digital dashboard to visualize pancreatic cancer patient data was highly feasible, usable, and efficient. Future directions of tool use include refining based on qualitative feedback from end users and planning for data automation and interoperability with the EMR.

Actual and perceived gender differences in virtual tumor board participation

IntroductionParticipant characteristics are known to affect group discourse and discussion outcomes. In medicine, many decisions are made by group consensus, therefore an understanding of these factors is highly relevant. We aimed to measure the effects of participant characteristics on tumor board discussions. MethodsWe performed a prospective, multi-institution, quantitative study of multi-disciplinary virtual tumor board meetings. Participant characteristics included age, gender, and clinical discipline. Outcomes of interest were speech events, duration, and discourse style. Participant impressions was assessed by a post-hoc survey. ResultsA total of 361 cases were discussed across 32 virtual meetings. Of the 283 attendees, 66.4 % were women, and all moderators were men. Women comprised 43 % of the 54 speakers, thus speaking less than male attendees (p < 0.001). No significant differences were detected in the duration or style of speech between men and women. Women participants commented more frequently on cases where the clinical attending was a woman (4.09 comments by women vs. 2.99 comments by men, p < 0.001), and less frequently when the attending was a man (2.48 comments by women vs. 3.20 comments by men, p < 0.001). On post hoc survey, men responded that they introduced ideas, guided discussions, and succeeded in influencing decisions significantly more than women reported that they did. ConclusionWomen physicians were underrepresented in tumor boards as moderators, speakers, and attendings of record. Women physicians commented less on men physicians' patients. Women felt less impactful than their men counterparts, despite having the same duration and style of speech. Prompted participation, moderator feedback, talking points, and limiting the number of cases can be used to balance representation in discussions.

Genetic counselling referral practices for patients with pancreatic adenocarcinoma: A French retrospective multicentre observational cohort study (CAPANCOGEN)

Background/objectivesGenetic counselling (GC) is a key step in the identification of inherited germline mutations. However, the oncogenetic practices are poorly described for pancreatic adenocarcinoma (PA) in Europe. The CAPANCOGEN study aimed to describe the GC referral practices in France and assess the implementation of international guidelines in patients with PA. MethodsInformation about GC referrals with PA was collected in 13 French centres from September 2019 to October 2021. In the 5 largest centres, personal and familial histories of cancers and diseases associated with a higher risk of germline mutations were collected in 460 patients, according to international, American, European and French GC referral guidelines. Univariate and multivariate logistic regression analysis were performed to identify the factors influencing GC referral. ResultsAmong 833 patients, a total of 100 patients (12%) had an indication of GC according to local multidisciplinary tumour board meetings (MTBM). Among these patients, 41% did not undergo GC. The median time between MTBM and GC was 55 days (IQR: 14.5–112). Among 460 patients with collected personal and familial history, 31.5% were not referred to a GC despite an existing indication. In multivariate logistic regression analysis, suspected CDKN2A (p = 0.032) or BRCA mutation (p < 0.001), familial pancreatic cancer history (p < 0.001) and controlled disease with first-line platinum-based chemotherapy (p < 0.001) increased the referral rate. Conversely, older age (p = 0.002) and a locally advanced PA (p = 0.045) decreased the risk of GC referral. ConclusionsGC referral is inadequate despite valuable information in patients’ medical files.

Teaching Potential of Multidisciplinary Tumor Board Meetings for Orthopedic Residents: Insights From a French Sarcoma Reference Center.

Multidisciplinary tumor boardmeetings (MTBMs) have been established in oncology to improve patient care. While their benefits for patients have been well-documented, there are no previous studies on the teaching opportunities they provide for residents and medical students. This study aimed to examine the teaching provided to residents during MTBM and identify areas for improvement. The study hypothesized that although the primary objective of MTBM is not teaching, they could still contribute to residents' learning. The study focused on the tumors board meeting for bone metastasis and musculoskeletal tumors/sarcoma in a French reference center for musculoskeletal oncology. The composition of the MTBM included specialists from various disciplines, and it convened on a weekly basis to discuss cases. The orthopedic oncology residents (OORs) actively participated in the MTBM as part of their training. A questionnaire was distributed to OORs who had served between 2014 and 2021, and their responses were analyzed. The results showed that the OOR perceived MTBM as interesting, beneficial for their training, and challenging. While opinions were divided on whether MTBM was a suitable place for education, the majority believed it improved their knowledge of different specialties and provided valuable elements applicable to daily practice. They also felt it facilitated future access to MTBs if needed. OORs recommended the rotation as an orthopedic oncology resident to younger residents. Recommendations for improvement included incorporating more dedicated teaching time, active involvement of residents in the learning process, availability of learning materials, and post-MTBM debriefing sessions. The study highlighted the importance of case presentations, public speaking skills, interdisciplinary collaboration, and clinical reasoning observed during MTBM. In conclusion, while not primarily designed for teaching, MTBM offers valuable learning opportunities for residents. Enhancing the teaching experience through dedicated debriefing sessions, resident involvement, and improved support can further optimize their educational impact. Future evaluations are needed to assess the effectiveness of these improvements. This study provides insights into the teaching potential within MTBM and can guide educational initiatives in the field of oncology.

Utilization of a Virtual Tumor Board for the Care of Patients With Renal Masses: Experience From a Quality Improvement Collaborative.

Multidisciplinary tumor board (MDTB) meetings are useful sources of insight and collaboration when establishing treatment approaches for oncologic cases. However, such meetings can be time intensive and inconvenient. We implemented a Virtual Tumor Board (VTB) within Michigan Urological Surgery Improvement Collaborative (MUSIC) to discuss and improve the management of complicated renal masses (RMs). Urologists were invited to discuss decision-making for RMs through voluntary engagement. Communication was performed exclusively through email. Case details were collected and responses were tabulated. All participants were surveyed about their perceptions of the VTB. 50 RM cases were reviewed in a VTB that included 53 urologists. Patients ranged from 20-90 years old and 94% had localized RM. The cases generated 355 messages, ranging from 2-16 (median 7) per case; 144 responses (40.6%) were sent via smart-phone. All urologists (100%) who submitted to the VTB had their questions answered. The VTB provided suggestions to those with no stated treatment plan in 42% of cases, confirmed the physician's initial approach to their case in 36%, and offered alternative approaches in 16% of cases. 83% of survey respondents felt the experience was "Beneficial" or "Very Beneficial" and 93% stated increased confidence in their case management. MUSIC's initial experience with a VTB showed good engagement. The format reduced barriers to multi-institutional and multi-disciplinary discussions and improved the quality of care for selected patients with complex RMs.

Physician compliance with multidisciplinary tumor board recommendations for managing gynecological cancers.

Aims: Evaluation of compliance with gynecological multidisciplinary tumor board (MTB) recommendations and its impact. Patients & methods: All patient records discussed in our MTB from 2018 to 2020 were analyzed. Results: We analyzed 437 MTB recommendations concerning 166 patients. Each patient was discussed an average of 2.6 (1.0-4.2) times. Of the 789 decisions, the decision was not followed 102 times (12.9%), corresponding to 85 MTB meetings (19.5%). Of these, 72 recommendations concerned therapeutic changes (70.5%), and 30 concerned non-therapeutic changes (29.5%). Of these 85 MTB decisions, 60 (71%) led to a new MTB submission. Noncompliance with MTB decisions decreased the overall survival (46 vs 138months; p=0.003). Conclusion: Improving compliance with MTB decisions is crucial to enhance patient outcomes.

Breast Cancer Tumor Board: A Radiologist’s Guide to Postmastectomy Radiation Therapy

Radiation therapy represents a pillar in the current management of breast cancer. Historically, postmastectomy radiation therapy (PMRT) has been administered only in patients with locally advanced disease and a poor prognosis. These included patients with large primary tumors at diagnosis and/or more than three metastatic axillary lymph nodes. However, during the past few decades, several factors have prompted a shift in perspective, and recommendations for PMRT have become more fluid. Guidelines for PMRT in the United States are outlined by the National Comprehensive Cancer Network and the American Society for Radiation Oncology. Because evidence to support performing PMRT is frequently discordant, the decision to offer radiation therapy often requires team discussion. These discussions are usually held in multidisciplinary tumor board meetings in which radiologists play a pivotal role by providing critical information such as the location and extent of disease. Breast reconstruction after mastectomy is optional and is safe in cases in which the patient's clinical status allows it. The preferred method in the setting of PMRT is autologous reconstruction. If this is not possible, then a two-step implant-based reconstruction is recommended. Radiation therapy does involve a risk of toxicity. Complications can be seen in acute and chronic settings and range from fluid collections and fractures to radiation-induced sarcomas. Radiologists have a key role in detecting these and other clinically relevant findings and should be prepared to recognize, interpret, and address them. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.

The painting of a patient: Provider representations of patient fitness and preferences in multi-disciplinary tumor board meetings.

246 Background: Pancreatic cancer treatment can involve multiple treatment modalities (e.g. chemotherapy, surgery, radiation) that vary greatly in intensity and timing. The most intense treatments are associated with substantial toxicity and only recommended for medically ‘fit’ patients regardless of age. Despite evidence-based guidelines demonstrating the benefit of including the geriatric assessment (GA) and patient preferences, these may not be formally included in multidisciplinary tumor boards (MDTBs) where treatment decisions are often made. Methods: This qualitative study evaluated MDTB meetings at a single institution between November 2021 and February 2022 for inclusion of fitness and patient preferences. Discussions of patients with stage I-IV pancreatic cancer were identified for inclusion. These recordings were transcribed and analyzed using NVivo for recurring themes and exemplary quotes regarding how providers characterize patients’ fitness and present their preferences to the board. Results: Thirteen MDTB meetings including 50 individuals with stage I-IV pancreatic cancer were included. Descriptions of patient fitness largely consisted of the presentation of common demographic traits such as age and gender. Additional context, primarily focused on occupation, comorbidities, and patient attitudes, was provided when demographic information did not align with perceived fitness level; for example “He’s 60 years old. He’s actually very strong. He used to, or he does, work in landscaping”. There was no formal inclusion of GA data. Explicit references to patient preferences or agentive decision-making only occurred in 19 cases; 11 referring to the patient’s (non-)interest in clinical trials, 3 denying additional testing (tone suggesting non-compliance), and 7 specifically referring to treatment type preference (e.g. surgery vs. chemotherapy). Conclusions: At present, MDTB treatment discussions primarily rely on shared understandings of the cultural significance and meaning of various demographic traits and rarely reference patient-reported preferences or fitness when determining the best pathway for patient care. Further work is needed to understand how to better formally incorporate fitness and preferences into decision-making.

Real-world practice patterns in multidisciplinary squamous cell carcinoma care at community oncology centers.

261 Background: As the incidence of cutaneous squamous cell carcinoma (cSCC) continues to rise and newer systemic therapies become available, coordination of care between dermatologists and oncologists will be vital to provide quality, patient-centered care. Methods: Between 8/17/2020 and 11/30/2020, we surveyed dermatology team members (n = 50) and oncology team members (n = 54) at 5 community oncology practices to assess current practices, challenges/barriers, and areas for improvement in multidisciplinary care of cSCC. Providers then participated in audit/feedback educational sessions and developed action plans to address identified gaps. Results: A majority of providers (72%) reported “very low” or “low” levels of care coordination between oncology and dermatology teams (5-point Likert scale). The three main barriers identified by dermatology/oncology teams included lack of relationship to other specialties (36%/47%), lack of multidisciplinary tumor board (30%/36%), and difficulty with patient navigation to follow-up and monitoring (44%/29%). In addition, lack of administrative support (30%/47%), lack of time (54%/42%), and high case load (32%/16%) hindered multidisciplinary tumor board meetings. Overall, dermatology teams reported lower confidence in making treatment decisions for patients with advanced cSCC compared to oncology teams. Specific strategies were identified to bridge these gaps and improve cSCC care including improving electronic communication, coordinating treatment plans with multidisciplinary teams, integrating educational seminars between oncologists and dermatologists, and finding better multimodality therapeutic options. Conclusions: These findings reveal important challenges in multidisciplinary care of cSCC in community oncology clinics. The identified gaps may inform future implementation science initiatives, and represent key opportunities for improvement in cSCC patient care.[Table: see text]

Individualized Approach in the Surgical Management of Hepatocellular Carcinoma: Results from a Greek Multicentre Study.

Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of death worldwide. The management of HCC is complex, with surgical treatment providing long-term survival in eligible patients. This study aims to present the experience of aggressive surgical management of HCC in Greece. Methods: This is a retrospective multicentre clinical study with 242 patients. Results: Most patients were male (79%) and had a median age of 71 yrs. According to the most recent BCLC criteria, 172 patients (71.1%) were classified as BCLC 0-A stage, 33 patients (13.6%) were classified as BCLC B, and 37 (15.3%) were classified as BCLC C. A total of 54% of the patients underwent major hepatectomy. Major postoperative morbidity was 15.6%, and the 90-day postoperative mortality rate was 4.5%. The median follow-up was 33.5 months. Three- and five-year overall survival was 65% and 48%, respectively. The median overall survival was 55 months. Significantly, five-year survival was 55% for BCLC A, and 34% and 21% for BCLC B and C, respectively. In univariate analysis, cirrhosis, type of resection (R status), and BCLC stage were associated with overall survival. Multivariate analysis indicated that R1 and R2 resections compared to R0, and BCLC C compared to BCLC 0-A, were independently associated with increased mortality. Conclusions: Aggressive surgical treatment of HCC offers satisfactory long-term survival prospects. A significant percentage (29%) of HCCs that underwent liver resection were of the intermediate and advanced BCLC stage. The management of patients with HCC should be discussed in multidisciplinary tumour board meetings on a case-by-case basis to be more effective.

IMPACT OF COMPREHENSIVE GENOMIC PROFILING NGS PANELS IN PRECISION ONCOLOGY: THE CITY OF HOPE CMDL EXPERIENCE

The City of Hope (COH) Comprehensive Cancer Center provides a multidisciplinary, collaborative environment where basic, clinical, and translational research intersect and is recognized as one of the leaders in cancer treatment. The COH Clinical Molecular Diagnostic Laboratory (CMDL) has been a pioneer in molecular diagnostics with over twenty years of clinical experience in both somatic and germline molecular testing. The CMDL has been offering multiple next generation sequencing (NGS)-based comprehensive genomic profiling panels, HopeSeq Panels, for many years to guide clinicians in diagnosis, prognosis, and therapeutic strategies in cancer treatment by providing expanded coverage for the clinical trials and the gene targets which are recommended and cited by the professional organizations including the World Health Organization (WHO), the European Leukemia Net (ELN), the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO). Being a designated laboratory for the NCI-ComboMATCH study by the National Cancer Institute (NCI), these comprehensive genomic profiling panels have strengthened COH’s leading position in cancer research and treatment and have further expanded its position as a leading provider of Precision Oncology. The comprehensive genomic profiles of each patient are reviewed in daily multidisciplinary genomic tumor board meetings by an expert team which includes molecular pathologists, clinical molecular geneticists, hematopathologists and clinicians prior to reporting to ensure the variants are appropriately classified based on AMP/ACMG guidelines in the context of the patient’s cancer.&nbsp;

Virtual Tumor Board Increases Provider Attendance and Case Presentations.

Many cancer centers engage in multidisciplinary tumor board meetings to determine the optimal approach to complex cancer care. With the onset of the COVID-19 pandemic, many institutions changed the format of these meetings from in-person to virtual. The aim of this study was to determine if the change to a virtual meeting format had an impact on attendance and cases presented. Tumor board records were analyzed to obtain attendance and case presentation information at a National Cancer Institute-designated Comprehensive Cancer Center. Twelve-month in-person tumor board data were compared with 12-month virtual tumor board data to assess for difference in attendance and case presentation patterns. Seven separate weekly tumor board meetings at the beginning of the study (breast, GI, gynecology, liver, lung, melanoma, and urology) were expanded to nine meetings on the virtual platform (+endocrine and pancreas). Overall attendance increased by 46% on the virtual platform compared with in-person meetings (4,030 virtual attendances v 2,753 in-person, P < .001). Increased attendance was present across all specialties on the virtual platform. In addition, the number of patient cases discussed increased from 2,127 in in-person meeting to 2,656 on the virtual platform (a 20% increase, P < .001). A significant increase was observed in overall tumor board attendance and in case presentations per meeting, requiring the expansion of additional weekly meetings. Furthermore, in a major cancer center with multiple community affiliates, virtual tumor boards may encourage increased participation from remote sites with the benefit of obtaining expert specialist advice as compared with geographically challenging in-person meetings.

Percutaneous cryoablation for desmoid fibromatosis: initial experience at a UK centre

To report the first UK experience of cryoablation in desmoid fibromatosis (DF) with particular focus on technique, safety, and efficacy. Patients were selected at multidisciplinary tumour board meetings at a specialist cancer hospital. Radiation dose, procedure duration, and number of cryoprobes were compared for small versus large tumours (>10 cm long axis). Response at magnetic resonance imaging (MRI) was evaluated using different criteria, and percentage agreement with clinical response as assessed in oncology clinic calculated. Thirteen procedures were performed in 10 patients (eight women, median age 51 years, IQR 42-69 years) between February 2019 and August 2021. Procedures for large tumours had higher radiation dose (2,012±1,012 versus 1,076±519 mGy·cm, p=0.048) used more cryoprobes (13±7 versus 4±2, p=0.009), and were more likely to have residual unablated tumour (38±37% versus 7.5±10%, p=0.045). Adverse events were minor apart from one transient radial nerve palsy. Eight of 10 patients had symptomatic benefit at clinical follow-up (median 353 days, IQR 86-796 days), and three started systemic therapy mean 393 days later. All patients who had complete ablation demonstrated symptomatic response, with no instances of repeat treatment, recurrence, or need for systemic therapy during the study period. All progression occurred outside ablation zones. Cryoablation for symptomatic DF is a reproducible technique with low, transient toxicity, where one or two treatments can achieve a meaningful response. Where possible, the ablation ice ball should fully cover DF tumours.

LINC-12. Encouraging early outcomes with image guided pencil beam proton therapy for cranio-spinal irradiation and unique considerations for paediatric population – First report from India

BACKGROUND: To report our experience with image guided pencil beam proton beam therapy (PBT) for craniospinal irradiation (CSI). MATERIALS AND METHODS: Between January 2019 to Dec 2021, we carried out a detailed audit of the first forty patients treated with PBT. All patients were carefully selected after approval from our institutional multidisciplinary tumour and proton board meetings. Median age of the patient cohort was 8 years, and histologies include 20 medulloblastoma, 7 recurrent ependymoma, 3 pineoblastoma, 3 were germ cell tumors and remaining 7 constituted other diagnoses. Forty percent patients received concurrent chemotherapy. We had recorded acute toxicities on a prospectively maintained database. We also report early outcomes in this cohort and discuss limitations of current contouring guidelines during CSI PBT planning. RESULTS: Median CSI dose was 23.4 GyE (Gray Equivalent; range 21.6 - 35). Thirty-five patients (87.5%) completed their CSI without interruption as an outpatient procedure. Five patients required hospital admission during treatment, while one developed grade 3 mucosal toxicity, requiring plan adaptation and treatment break. No patient had grade 2 or more weight loss during the treatment. Forty-five percent (18) developed grade 1 hematological toxicities and 20% (8) developed grade 2 or 3 toxicities; none had grade 4 toxicities. At median follow up of 12 months, 90 % patients are alive of whom 88.9 % are having local control. Special consideration with modification in standard contouring used at our institute helped in limiting acute toxicities in paediatric CSI patients. CONCLUSION: Our preliminary experience with modern contemporary PBT using pencil beam technology and daily image guidance in a range of tumours suitable for CSI is encouraging. Patients tolerated the treatment well with acceptable acute toxicity and expected short-term survival outcome. In paediatric CSI patients, modification in standard contouring guidelines required to achieve better results with PBT

Re-Imagining the Data Collection and Analysis Research Process by Proposing a Rapid Qualitative Data Collection and Analytic Roadmap Applied to the Dynamic Context of Precision Medicine

Our implementation science study focuses on implementing a new way of practice and offers methodological specificity about how to rapidly investigate an individually tailored precision medicine intervention. A qualitative study advancing a new methodology for speedily identifying barriers and enablers to implementation in the context of childhood cancer. Data were collected through rapid ethnography, coded using the Consolidated Framework for Implementation Research, and analysed by Sentiment Analysis. Thirty-eight data collection events occurred during 14 multidisciplinary tumour board meetings, 14 curation meetings, and 10 informal conversations. Sentiment Analysis distilled Consolidated Framework for Implementation Research codes to reveal key barriers and enablers to implementation. A traffic light labelling system has been used to present levels of positivity and negativity (green for strong enablers and red for strong barriers), highlighting levels of concern regarding implementation. Within the intervention design characteristics, “Adaptability” was the strongest enabler and “Design quality and safety” the strongest barrier. Among the contextual factors: “Networks and communication” were the strongest enabler, and “Available resources” were the strongest barrier. Overall, there was a higher percentage of negative sentiment towards intervention design characteristics and contextual factors than positive sentiment, while more concerns were raised about intervention design factors than contextual factors. This study offers a rapid qualitative data collection and analytic methodological roadmap for establishing barriers and enablers to a paediatric precision medicine intervention.

INNV-27. AN INNOVATIVE VIRTUAL MULTI-INSTITUTIONAL, MULTIDISCIPLINARY NEURO-ONCOLOGY TUMOR BOARD: THE NIH-NOB EXPERIENCE DURING THE COVID-19 PANDEMIC

BACKGROUNDThe American Academy of Neurology Institute and Society for Neuro-Oncology recommend multidisciplinary tumor board (MTB) meetings as a quality metric in neuro-oncology. With the COVID-19 pandemic resulting in travel restrictions, we expanded our existing MTB by transitioning to a virtual format that maintained our commitment to providing consultation for primary CNS tumor cases. This transition permitted participation by neuro-oncology teams from over 30 Brain Tumor Trials Collaborative (BTTC)/National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) centers across the United States. Here, we describe results from opening our MTB remotely to these teams.METHODSWe retrospectively reviewed records from remote MTB meetings held between April 2020 and March 2021. To gauge the impact of our MTB on clinical management, we administered a brief survey querying BTTC members.RESULTSTwenty-eight providers presented 41 cases during 24 virtual MTB meetings (range: 1-4 cases per meeting). Two cases (5%) were presented only for educational value. Approximately half (54%) of the cases discussed dealt with diagnosis/management of an NCI-CONNECT rare CNS tumor. During MTB discussions of the 39 cases seeking diagnosis/management recommendations, 32% received clinical trial recommendations, 10% were suggested to enroll in the NCI Neuro-Oncology Branch (NOB) Natural History Study (NCT02851706), 17% received a recommendation to obtain central neuropathology review, and 100% received recommendations for further disease management. Most BTTC survey respondents (83%) found these recommendations impactful in the management/treatment of their presented case or generally useful/informative for their clinical practice.CONCLUSIONWe describe the feasibility and utility of an innovative virtual multi-institutional MTB. These novel remote meetings allowed for discussion of complex neuro-oncology cases and recommendations from experts, particularly important for those with rare CNS tumors. Our study’s findings during the COVID-19 pandemic of the value of providing remote access to MTBs should apply post-pandemic.

Do Tumor Board Recommendations Influence the Decisions of Clinicians in Planning the Treatment of Head and Neck Cancers?

Objective: The aim of this study is to compare the decisions made at established tumor board meetings for planning the treatment of head and neck cancer patients with the individual treatment decisions of clinicians who attended the meetings. Material and Methods: A total of 188 patients with head and neck tumors were included in this study, all of whom had been evaluated at weekly tumor board meetings at our clinic. The tumor board consisted of otolaryngologists, radiation oncologists, medical oncologists, pathologists, and radiologists. Before the board meetings, all data belonging to the patients were given to the otolaryngology surgeons and radiation oncologists who were to attend. Their treatment preferences were asked of them individually. The treatment options that clinicians recommended individually prior to board meetings were compared with the decisions made by the tumor board. Results: It was observed that 34% (64 cases out of 188) of the individual decisions made by ENT surgeons and 34.6% (65 cases out of 188) of those made by radiation oncologists changed following tumor board meetings. There was a statistically significant difference between the treatment options offered individually by both ENT surgeons and radiation oncologists and the treatment recommendations made by the tumor board. Conclusion: According to the data we obtained, the recommendations for treating patients with head and neck cancers made by the tumor boards may differ from the personal decisions of attending clinicians. Therefore, to make decisions that ensure the highest quality patient care, we believe it is necessary to evaluate all patients with head and neck tumors at multidisciplinary tumor board meetings regardless of cancer stage.

Effect of COVID-19 on Thoracic Oncology Surgery in Spain: A Spanish Thoracic Surgery Society (SECT) Survey.

Simple SummaryAfter the first wave of COVID-19, the Spanish Society of Thoracic Surgeons (SECT) surveyed its members to assess the impact of the pandemic on thoracic oncology surgery in one of the counties most affected by the virus. In May 2020, all SECT members were invited to complete a 40-item, multiple choice questionnaire by e-mail. The response rate was 19.0%. Surgical activity decreased by 95.7%, with 41.5% of centers performing surgery only in oncologic cases and 11.7% only in emergencies. More than half (56%) of multidisciplinary tumour board meetings (56%) were cancelled or conducted online. Standard protocols for early-stage disease were modified in 62.9% of centers. The results of this survey show that the COVID-19 pandemic severely limited thoracic oncology surgery activity. Here we describe and discuss the impact of the pandemic on thoracic surgery in Spain.After the first wave of COVID-19, the Spanish Society of Thoracic Surgeons (SECT) surveyed its members to assess the impact of the pandemic on thoracic oncology surgery in Spain. In May 2020, all SECT members were invited to complete an online, 40-item, multiple choice questionnaire. The questionnaire was developed by the SECT Scientific Committee and sent via email. The overall response rate was 19.2%. The respondents answered at least 91.5% of the items, with only one exception (a question about residents). Most respondents (89.3%) worked in public hospitals. The reported impact of the pandemic on routine clinical activity was considered extreme or severe by 75.5% of respondents (25.5% and 50%, respectively). Multidisciplinary tumour boards were held either with fewer members attending or through electronic platforms (44.6% and 35.9%, respectively). Surgical activity decreased by 95.7%, with 41.5% of centers performing surgery only on oncological patients and 11.7% only in emergencies. Nearly 60% of respondents reported modifying standard protocols for early-stage cancer and in the preoperative workup. Most centers (≈80%) reported using full personal protective equipment when operating on COVID-19 positive patients. The COVID-19 pandemic severely affected thoracic oncology surgery in Spain. The lack of common protocols led to a variable care delivery to lung cancer patients.

Virtual Multidisciplinary Review of a Complex Case Using a Digital Clinical Decision Support Tool to Improve Workflow Efficiency.

ObjectiveIntegration of distinct clinical perspectives in multi-disciplinary tumor board meetings is critical to determine optimal patient care. Digital tools can support the data consolidation needed for meeting preparation and data sharing during complex case reviews. In this paper, we assessed the value of a clinical decision support tool on workflow efficiency and conducting a complex case review of a dermatofibrosarcoma protuberans (DFSP) tumor.MethodsCase presentation was performed by each unique clinical specialty that had relevant information about the patient; an oncologist, a pathologist, and a radiologist. Virtual discussion was completed online with case presentation and documentation with NAVIFY Tumor Board. Workflow efficiency assessment was done through interviews and observation of the # of steps across different team members involved in preparing and conducting cancer multidisciplinary team (MDT) meetings before and after the implementation of the NAVIFY Tumor Board solution.ResultsCase review consisted of surgical and therapeutic intervention history, distinct histological and sequencing patterns representative of DFSP, with radiological review to determine areas for surgical intervention. Consolidation of clinical input led to a recommendation of a formal external hemipelvectomy with potential chemotherapy. Workflow assessment demonstrated a 46% total reduction in the # of steps for meeting preparation (from 69 to 37), with specific changes based on role: data manager (33 to 15), pathologist (26 to 13), radiologist (no change), and logistics (5 to 4). There was a 31% total reduction in the # of steps for conducting the meeting (from 51 to 35).ConclusionUtilizing a digital clinical decision support tool helped to consolidate patient data and improved case presentation through workflow efficiency. This allowed for improved interdisciplinary discussion on a complex DFSP case and supported the determination of a clinical decision.

Impact of optional multidisciplinary tumor board meeting on the mortality of patients with gastrointestinal cancer: A retrospective observational study.

BackgroundMultidisciplinary tumor board meetings (MDTs) have shown a positive effect on patient care and play a role in the planning of care. However, there is limited evidence of the association between MDTs and patient mortality and in‐hospital morbidity for mixed cases of gastrointestinal (GI) cancer.AimTo evaluate the influence of optional MDTs on care of patients with cancer to determine potential associations between MDTs and patient mortality and morbidity.Methods and resultsThis was a retrospective observational study at the referral center of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Among all adult patients diagnosed with GI cancer from January 2017 to June 2019, 130 patients were included. We categorized patients into two groups: 66 in the control group (non‐MDT) and 64 in the MDT group. The main outcome measure was overall mortality, measured by survival analysis. The follow‐up was 100% complete. Four patients in the MDT group and 13 in the non‐MDT group died (P = .04). The median follow‐up duration was 294 days (interquartile range [IQR], 140‐434) in the non‐MDT group compared with 176 days (IQR, 103‐466) in the MDT group (P = .20). There were no differences in intensive care unit or hospital length‐of‐stay or admission rates. The overall mortality at 2 years was 13% (95% confidence interval [CI], 0.06‐0.66) in the MDT group and 38% (95% CI, 0.10‐0.39) in the non‐MDT group (P = .08). The MDT group showed a 72% (adjusted hazard ratio [HR], 0.28; 95% CI, 0.08‐0.90; P = .03) decrease in mortality over time compared with the non‐MDT group.ConclusionsMDTs were associated with decreased mortality over time. Thus, MDTs have a positive influence on patient care by improving survival and should be incorporated into care.