Are Tumor Boards a Waste of Time?

Nick Mulcahy

December 28, 2012

Tumor boards may not improve the quality of oncology care, according to the results of a new study published December 28 in the Journal of the National Cancer Institute.

And that is a problem because improving performance is the whole point of these multidisciplinary team meetings, which include medical, surgical, and radiation oncologists as well as pathologists, imaging specialists, social workers, and others.

Study investigators found only a modest association between the presence of tumor boards and the recommended, stage-specific cancer care in a study of 138 Veterans Affairs (VA) medical centers.

"This could mean that tumor boards did not, in fact, influence quality of cancer care in the VA setting," write the authors, led by Nancy L. Keating, MD, MPH, of the Harvard Medical School in Boston, Massachusetts.

"This was disappointing to us; we'd expected to see that cancer-specific tumor boards make a difference," she told Medscape Medical News.

The problem is not the VA, whose cancer patient care is "generally similar to or better than care delivered to individuals insured under fee-for-service Medicare," say Dr. Keating and her colleagues.

The new study expands upon earlier, single-center studies on this topic.

The investigators identified 27 measures of quality and linked cancer registry and administrative data to assess receipt of stage-specific care and outcome among cancer patients diagnosed in 2001-2004. The data were limited to colorectal, lung, prostate, hematologic, and breast cancers. They found that 75% of the VA centers had tumor boards, and many had multiple boards.

But only 1 of the 27 measures was statistically significantly associated with tumor boards when a rigorous statistical method was used (a Bonferroni correction for multiple comparisons).

When the analysis was less rigorous, 7 of the 27 measures were associated with tumor boards. However, some of these associations were not expected or desirable.

For example, one measure of standard, recommended care was the use of white blood cell growth factors with cyclophosphamide, doxorubicin, vincristine, and prednisone in diffuse large B-cell lymphoma. But, oddly, such usage was 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%; P = .002).

Team Meetings Are Not Very Helpful

The fact that "team meetings" do not improve the performance on measures of quality care "should be of no surprise," writes Doulgas Blayney, MD, in an accompanying editorial. He is from the Stanford Cancer Institute in California.

Anyone who has ever played a team sport or led a patient care team knows that such meetings "don't get the job done," he writes.

What is to be done? Dr. Blayney offers a number of ideas, including adopting technology such as video, which would allow participants to attend meetings at different times and places. He also highlights one main fault underlying the whole problem: there are team "huddles" at the VA, but "no feedback loop" for individual participants to recommend change. In short, Dr. Blayney describes the problem of unenlightened, hierarchical workplaces, where bosses dictate terms/guidelines and workers have little or no say.

Dr. Blayney and Dr. Keating and her colleagues all agree that tumor boards should not be thrown away.

Dr. Keating and her team call for more study and the fine tuning of tumor boards. "Additional research is needed to understand the structure and format of tumor boards that lead to the highest quality care," they write.

"More work is needed," says Dr. Blayney. And the structure, process, and outcome of tumor boards need a feedback loop, he concludes.

The study was funded by the Department of Veterans Affairs through the Office of Policy and Planning. The authors and editorialist have disclosed no relevant financial relationships.

J Natl Cancer Inst. DOI:10.1093/jnci/djs502, DOI:10.1093/jnci/djs523. Full article, Editorial