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Tumor boards had little effect on quality of cancer care
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Researchers who conducted a VA medical center survey observed little association between multidisciplinary tumor board reviews and higher rates of quality of cancer care.
Tumor board reviews provide a multidisciplinary approach to increasingly complex treatment planning. Despite their widespread use, few data on tumor boards’ effect on cancer care exist, according to background information in the study.
In the current investigation, researchers assessed whether tumor boards — either general or cancer specific — were associated with higher rates of recommended stage-specific cancer care or differences in use of care for veterans with colorectal, lung, prostate, hematologic and breast cancers.
Nancy L. Keating
Nancy L. Keating, MD, MPH, associate professor of medicine in the department of health care policy at Harvard Medical School, and colleagues surveyed 138 VA medical centers regarding the presence of tumor boards. Researchers also linked cancer registry and administrative data to assess stage-specific recommended care, survival or use in patients with cancer diagnosed from 2001 to 2004 and followed through 2005.
Keating and colleagues identified measures of high-quality care. These measures were developed based on national guidelines available during the study period.
According to study results, 75% (n=103) of the 138 surveyed facilities had at least one tumor board. Sixty-two centers had a single tumor board that discussed cases from multiple cancer sites. Forty-one centers had more than one disease-specific tumor board.
The presence of a tumor board was associated with only seven of 27 measures assessed (all P<.05). Most types of care for lung, prostate, hematologic and breast cancers were unaffected by the presence of tumor boards, Keating and colleagues found.
When researchers applied a Bonferroni correction for multiple comparisons, only one of the measures was statistically significantly associated: Patients with limited-stage small cell lung cancer who were at centers with a general tumor board or lung cancer-specific tumor board were more likely to undergo chemotherapy or radiation compared with patients treated at a center with no board.
“This could mean that tumor boards did not, in fact, influence quality of care in the VA setting,” the researchers wrote.
The results also could show that tumor boards are only as good as their structural components and the expertise of their participants, Keating and colleagues said. Measuring only on the presence of a tumor board may not be sufficient to understand its effects, they noted.
“Additional research is needed to understand the structure and format of tumor boards that lead to the highest quality of care,” the researchers concluded.
In an accompanying editorial, Douglas W. Blayney, MD, medical director for the Stanford Cancer Institute at the Stanford School of Medicine, wrote that tumor boards may carry greater influence at the smaller centers and health systems.
“Incremental changes in the tumor board infrastructure may increase the value of these team meetings and extend their potential benefits to low-volume physicians,” Blayney said.
Tumor boards have too long a history for them to be easily abandoned, but the work by Keating and colleagues provides a reason to change tumor board conduct, Blayney added.
“Most naturally occurring biological and physical systems have feedback loops,” Blayney wrote. “These loops can dampen or amplify changes as they move through the system. The tumor board or team meeting might be a much more powerful tool if its recommendations were actually carried out and if the reasons why or why not were known. Feedback loops for processes with a short time constant already exist (eg, chemotherapy dose adjustments based on toxicity), and we should also incorporate feedback loops with longer time constants.”
Disclosure: Keating reports no relevant financial disclosures.
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