The 'Tumor' in 'Tumor Board' Is a Problem, Says UK/US Team

More Patient-Centric Name Proposed

Nick Mulcahy

October 21, 2021

For the past 90 years, tumor boards have offered a place for various members of the cancer care team to discuss individual patient cases. But this global institution needs a name change ― and a related "paradigm shift" ― to improve its effectiveness, says a team of reformers.

The team proposes a new moniker: a meeting for "care planning for people with cancer."

Or CPPC meeting, for short.

This proposed rebranding of tumor boards is a "small but important step" that could have a positive effect on care, they suggest.

"We believe that reframing the meeting by changing the title might help shift, cognitively and linguistically, the stakeholder focus toward a more patient-centered discussion and recommendation," say the authors, led by Tayana Soukup, PhD, of King's College London, London, United Kingdom. Co-authors include academics from the University of Michigan, in Ann Arbor, Michigan.

Their proposal is outlined in an editorial published in the October issue of JCO Oncology Practice.

The widely used term "tumor board" puts the focus on biology and the isolated characteristics of a tumor and not the whole patient, they explain.

This "tumor-centric" focus persists despite recommendations that boards also consider patient-centered details of a case, such as psychosocial information, comorbidities, and the patient's own views and preferences about treatment.

That's a problem because, for decades, the tumor-centric focus has been shown to contribute to poor adherence to treatment recommendations by patients, write Soukup and colleagues.

It's time to ramp up the patient-centeredness of boards to improve care, they declare.

"We believe one critical barrier [to this improvement] may be hiding in plain sight: the very name tumor board," the team states. A tumor is an abnormal mass of tissue, but cancer happens to a person and their life, say the authors.

Approached for comment, Heidi Nelson, MD, medical director of cancer programs at the American College of Surgeons (ACS), said that the term "tumor board" is already a thing of the past in the eyes of the ACS. The organization's Commission on Cancer regulates these entities in the United States.

Tumor boards have "more recently evolved to become multidisciplinary cancer case conferences (MDCs)," she told Medscape Medical News in an email.

However, Nelson did not explicitly confirm that the ACS supports the idea of making conferences ― by any name ― more patient-centric, although she noted that case conferences consider variables such as supportive and palliative care.

Nelson, who is a former surgeon at the Mayo Clinic, in Rochester, Minnesota, said these meetings "are intended to help, not preclude, the shared decision making process that occurs between the cancer care team and patient."

That may be too late, suggest the editorial authors, because the "low patient-centeredness" of tumor boards/multidisciplinary conferences already "renders many recommendations inappropriate" for patients.

They also point out that alternative names for tumor boards are proliferating; as well as MCD, other names include tumor or cancer conference and multidisciplinary oncology tumor board.

Soukup and colleagues argue that it's "unknown" whether any new naming approach "is more attune to patient engagement or too vague to emphasize the increasingly patient-centered nature of the meeting content."

Unless the patient ― with all of their human complexity ― is front and center, things may be suboptimal, the editorialists suggest.

They cite the case of a German cancer patient who had attended that country's version of an MDC and who reported that it was "very stressful, the label 'MTC' (multidisciplinary tumor conference) alone…Like a tribunal."

Room for Improvement

ACS's Nelson provided some historical context. Tumor boards date back to 1931, when the then-called American College of Surgeons Committee on the Treatment of Malignant Diseases published their first "minimum standard for cancer clinics."

That standard required "regular conferences or consultations at which the diagnosis and treatment of the individual cases are discussed by all members of the clinic who are concerned with the case...."

Since then, evidence has accumulated as to the strengths and weaknesses of those tumor boards.

Care planned by tumor boards is concordant with best-evidence recommendations most of the time (66%), according to a 2018 study.

Nevertheless, that leaves room for improvement, say the editorial authors, because in 23% of cases, there was discordance between recommended and delivered care. Furthermore, in about a third of those cases, a "major" cause of the discordance was related to a lack of patient centeredness, they observe.

"Omission of patient preferences may result in recommendations at odds with patient goals," Soukup and colleagues write, although they acknowledge that this needs more research.

For instance, more information is needed about "evaluating the quality of tumor board recommendations against patient needs and values and exploring how such information can be effectively integrated into tumor board decision making to further enhance the quality and value of care provided."

The question here is whether the care proposed by physicians and healthcare professionals who sit on tumor boards matches up with patients' preferences.

Multidisciplinary cancer case conferences have repeatedly been shown to improve diagnoses and staging, as well as increase the application of evidence-based treatments, says Nelson. "No doubt, just as these conferences have evolved since they were first proposed, they will continue to be reconfigured as the cancer practice itself evolves," she added.

Soukup has financial ties to Roche and Sanofi Pasteur. Nelson is an employee of the American College of Surgeons.

JCO Oncol Prac. 2021 Oct;17:591-593. Full text

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