Case-Based, Weekly Tumor Boards May Improve Survival and Boost Clinical Trial Participation

Patients with certain lung and colorectal cancers whose physicians participated in weekly, treatment-focused tumor board meetings had improved survival and were 60% more likely to enroll in a clinical trial, according to the results of a survey involving nearly 5000 patients and 1600 oncologists.

The study, presented October 14 in advance of the 2014 ASCO Quality Care Symposium to be held October 17-18 in Boston, aimed to determine both the impact of multidisciplinary tumor boards on patient experience and outcomes, as well as the type of engagement these sessions provide for the healthcare professionals who attend them. Lead study author and presenter Kenneth L. Kehl, MD, noted that prior studies have been conflicting about the impact of tumor board participation on patient care.

For this Cancer Care Outcomes Research and Surveillance Consortium study, which drew on survey responses across multiple settings—ranging from solo or group practices to community hospitals and academic medical centers—patients were asked about communication with their healthcare providers, and physicians were asked if—and how frequently—they participate in tumor boards. Physicians also characterized the scope and purpose of these sessions, which, Kehl explained, tend to vary by region, specialty, and institution and haven’t been very well-described in the literature, even though tumor boards have been around for decades.

The researchers then used patient medical records to determine if tumor board participation was linked to clinical trial enrollment, receipt of curative treatment, patient-reported quality of care, and survival.

Overall, the vast majority of physician respondents (96%) indicated some level of tumor board participation: 54% said that they participated in tumor boards at least weekly, 26% indicated monthly participation, 8% responded they attend four times annually, another 8% said they participated in tumor boards less than quarterly, and just 4% never participate in tumor boards.

The nature of the sessions also varied, with respondents reporting that only 12% served a teaching function, rather than as a forum for discussing actual patient cases. Eighty-seven percent of respondents said the sessions reviewed multiple cancer types as opposed to only one tumor type, and 59% indicated that their tumor boards reviewed only challenging cases.

The study found a number of links between patient outcomes and the type and frequency of tumor boards, said Kehl, who is a fellow in cancer medicine at the University of Texas MD Anderson Cancer Center. For example, patients with stage I or II non—small cell lung cancer whose doctors attended weekly tumor boards were more likely to have curative-intent surgery.

In addition, he continued, “for patients with extensive-stage, small cell lung cancer or stage IV colorectal cancer, patients whose physicians participated in tumor boards weekly had lower mortality after adjustment for other physician and patient characteristics,” such as physician specialty, clinical volume, and NCI cancer center affiliation, and other patient clinical and demographic traits.

Kehl cautioned that because this study is based on observational analysis, “it would be hard to definitively say that these meetings directly impact survival for those patients,” and that further exploration is needed.

However, the clinical trial impact is more definitive.

“Patients whose doctors participated in tumor boards weekly were more likely both to discuss clinical trial participation and to actually enroll in a clinical trial,” said Kehl.

“This study supports our belief that good communication and coordination of multidisciplinary cancer care is beneficial for these complex patients,” said Gregory A. Masters, MD, FACP, FASCO, a lung cancer specialist at Christiana Care Health System in Newark, Delaware, and presscast moderator. “Certainly, there is still room to continue to improve our outcomes and our communication, but this study shows that many people are involved in [tumor boards], and their involvement improves the chances of people being enrolled in clinical trials which will benefit future patients.”

Reference

Kehl K, Landrum MB, Kahn L, et al. Tumor boards among physicians caring for lung and colorectal cancer patients. Presented at: 2014 ASCO Quality Care Symposium; October 17-18, 2014; Boston, MA. Abstract 179.