If you or a loved one is being treated for cancer, you may not be aware of so-called “tumor boards.” But if you’re getting care at a major academic or cancer-specific medical center, these regular face-to-face gatherings of cancer specialists—oncologists, radiologists, surgeons, pathologists, psychologists and others—play a key role in assessing individual cases. This may involve reviewing the pathology report…tracking disease progression…and discussing the treatment options for different types of cancer.
What gets reviewed: If your case comes before a tumor board, the doctors likely will address a variety of issues. Is surgery an option or will radiation and/or chemotherapy be more appropriate? If surgery can be done, should it or chemotherapy be used first, followed by other treatments? Is this patient battling mental health issues…or getting the runaround from insurance to get coverage for certain drugs?
HOW TUMOR BOARDS HELP
Cancer care is rarely a straightforward process. From the time you are diagnosed until your treatments end, your care will depend on the opinions of a surprising number of specialists—and good communication among those experts can strongly affect how well you do.
Important recent finding: Among nearly 5,000 patients with colorectal and lung cancers, those whose doctors participated in weekly tumor boards lived longer, according to a study presented at a symposium of the American Society of Clinical Oncology.
To ensure that the medical center where you’re being treated relies on a tumor board’s guidance, you should seek out a cancer center designated by the National Cancer Institute or accredited by the Commission on Cancer.
Large cancer centers usually have separate tumor boards for different types of cancer. At smaller programs, a single board will review all or most cancer cases.
Tumor boards provide important oversight because what seems like a perfect treatment plan can fall short in real-world circumstances. For example, chemotherapy might be the recommended treatment for a specific cancer, but a tumor-board oncologist might argue that a particular patient isn’t healthy enough to withstand the treatment. A psychologist or social worker at a meeting might point out that the patient will need transportation to and from the chemotherapy clinic.
WHO GETS REVIEWED?
At MD Anderson Cancer Center and other large cancer centers, virtually all cases are discussed at a tumor board, although doctors give most of their attention to rare/complicated cases. There’s no separate charge to patients for the review.
My advice: If you’re not sure that your case has been discussed at your treatment center’s tumor board, ask your doctor whether it has been (or will be). Your doctor should not be offended by this question—especially if he/she will be presenting the case. If your case hasn’t been reviewed, ask why not. You have the right to request a tumor board review, but it might not be available at a smaller medical center.
Most tumor boards meet weekly or twice a month and are comprised of a dozen or more specialists, including surgeons, medical oncologists, radiation oncologists and pathologists. Depending on the cancer, other doctors—gynecologists, urologists, etc.—may participate. Meetings often include a nutritionist, nurses, mental health experts and a social worker.
Your case might go before a tumor board prior to treatment…after a preliminary treatment plan has been initiated…or during treatment when there is an important change in clinical circumstances.
Important finding: When the records of more than 200 pancreatic cancer patients collected from various institutions without tumor boards were later evaluated by a panel at Johns Hopkins University School of Medicine that included medical and radiation oncologists, surgical oncologists, pathologists and other experts, treatment changes were recommended in nearly 25% of these cases.
Research also shows that patients tend to have better outcomes in terms of treatment responsiveness, recovery times and survival, among other factors, when their cases are discussed at a tumor board.
Also: Patients whose cases are reviewed are more likely to be guided to a clinical trial—one that their primary oncologist might not be aware of. Many cancer patients are eligible for these trials, which provide excellent care…yet only about 3% of patients ever participate. The more patients there are enrolled, the more quickly important clinical questions can be answered.
The National Cancer Institute website lists thousands of clinical trials that are looking for participants—to compare drug treatments, study new surgical techniques or radiation treatments, etc. Most tumor boards have a “checklist,” which includes the question of whether there is a trial for which the patient might be eligible.
THE PERSONAL TOUCH
The services provided by tumor boards go beyond the nuts and bolts of treatment. For example, many cancer patients lose weight during chemotherapy or radiation treatments. If poor nutrition is threatening your recovery—or even your ability to continue treatments, a nutritionist might recommend nutritional counseling, or even help you find a free meal service in your area.
Many cancer patients suffer from mental health issues—depression, bipolar disorder, etc. The best cancer plan won’t help if you’re unable (or unwilling) to continue treatments. A tumor board will attempt to address—or correct—all the issues that can affect how well or poorly you respond to treatments.
Patients don’t typically attend tumor boards. Many different cases are reviewed at any one meeting. The presence of a patient would affect the confidentiality of others’ personal health information.