Surprising findings about tumor board effectiveness in the VA system.
Tumor boards have been around for a long time, and are an American College of Surgeon’s Commission on Cancer Program accreditation expectation. These multidisciplinary boards generally meet at least monthly to prospectively review new cancer cases and discuss management approaches. Despite the widespread use of tumor boards, data on their effectiveness are limited.
Researchers led by Nancy L. Keating, MD, MPH from the Harvard Medical School in Boston assessed whether the presence of a tumor board (general or cancer specific) was associated with recommended cancer care. They surveyed 138 Veterans Administration (VA) medical centers (response rate 100%) about the presence of tumor boards, and linked cancer registry and administrative data to assess recommended care for, and survival of, patients with colorectal, lung, prostate, hematologic, and breast cancers.
Most facilities (75%) had at least one tumor board, and many had several cancer-specific tumor boards. Among the 41 centers with more than one tumor board, all had a lung cancer—specific tumor board, and nearly all (95%) had a colorectal cancer–specific tumor board. Most also had a prostate cancer–specific tumor board (83%), a hematologic cancer–specific tumor board (73%), and a breast cancer–specific tumor board (66%). Presence of a tumor board was associated with only seven of 27 measures assessed, and several associations were not in expected directions. Rates of some recommended care (e.g., white blood cell growth factors use for patients receiving R-CHOP) were lower in centers with hematologic-specialized tumor boards (39.4%) than in centers with general tumor boards (61.3%) or no tumor boards (56.4%).
The researchers observed little association of multidisciplinary tumor boards with measures of use, quality, or patient survival. They stated that this may reflect no effect or an effect that varies by structural and functional components and participants’ expertise, or may mean that tumor boards are only as good as their structural and functional components and the expertise of the participants. The full study results, published in the Journal of the National Cancer Institute, may be found at http://www.oxfordjournals.org/our_journals/jnci/press_releases/keatingdjs502.pdf.