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Online tumor boards help ensure underserved patients in developing countries treated ‘properly, cohesively’
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The nonprofit Global Cancer Institute has conducted global video-based online tumor boards for the past 7 years.
This effort allows physicians in developing countries to present their most challenging case scenarios to a panel of cancer experts in the United States.
The institute — founded by Paul Goss, MD, FRCP, MBBCh, PhD, of Massachusetts General Hospital and Harvard Medical School — aims to bring common U.S. interventions to developing countries for the acceleration of diagnosis, treatment and improvement of cancer survival rates around the world.
“Across the world, the global statistic is a 72% chance of mortality after receiving a cancer diagnosis of any type. This decreases to a 32% chance of mortality from cancer in the United States,” Goss told HemOnc Today. “There are many reasons why underserved populations of patients have poor outcomes around the world, and they represent the majority of cancer patients in the world.”
Goss spoke with HemOnc Today about how these global tumor boards are conducted, the benefits they provide, and how experts can participate and volunteer their time.
Question: How are these global tumor boards conducted?
Answer: The NCI mandates that all U.S.-based physicians see patients in multidisciplinary settings. Physicians from different disciplines come together around a cancer discussion or patient to come up with a unified plan so that the patient and the patients’ family do not hear discrepant advice on different days from different physicians. The NCI encourages health care providers to act as a team rather than individuals. This practice has been present for many years in the United States, but it is not a practice in many global countries. For these tumor boards, we get together online and form a ‘virtual room’ whereby every month, for 1 hour, we have a global breast cancer tumor board. On a different day each month, also for 1 hour, we have a global gynecologic oncology tumor board. These are the only two cancer types that we cover, because it is simply beyond our expertise to go into other cancer types. For the 1 hour, there are three patient cases presented by young oncologists. Each shared case is presented for about 10 minutes, and that is followed by discussion among the panel, composed of experts across medical centers such as Johns Hopkins, Northwestern University, The University of Texas MD Anderson Cancer Center and Massachusetts General Hospital. U.S. physicians discuss up-to-date care that would be planned in the United States for such a patient. After the tumor board is complete, we circulate international tumor guidelines that are adhered to here in the United States but are not adhered to in foreign countries. These international guidelines and discussions persuade doctors to behave in a unified collective way to ensure that patients are treated properly and cohesively. These tumor boards are enormously successful and popular.
Q: How many experts have sat on these tumor boards?
A: We are present in about 55 hospitals, involving about 600 doctors across all continents in the world. We ensure that there is a presence from every discipline. Each patient receives about 15 opinions for free from experts in the United States. This saves the patient the time and trauma of having to travel miles to receive expert opinions. We have found that the doctors who most need this type of continual education are those who do not have the time to attend international meetings, read the literature, or meet with or talk with their colleagues face to face.
Q: What benefits do these tumor boards provide?
A: We undertake surveys of these doctors through highly selected hypothetical cases and, occasionally, we publish them to show the state of the current patterns of practice. Our goal is to reconduct these surveys after 1 or 2 years of participating in tumor boards to show a shift in clinical practice. This is an educational tool for doctors, but our goal is to help underserved patients with cancer.
Q: Do you plan to expand these boards to address other tumor types?
A: At the moment, we do not have the capability to expand, but we have encouraged fellows who come to Boston to train with us for 6 months to 1 year to establish tumor boards once they return home in their home language. These physicians are taught to lead these tumor boards, and we encourage them to go home and expand the boards in their home countries and among their physician peers who are in remote areas. This has proved very successful to date. For example, we have started this in Brazil, Mexico and other South American countries, where tumor boards are conducted in Spanish. We have a tumor board in Brazil that is conducted in Portuguese. In these settings, rural physicians are able to meet other physicians from the city where they commonly refer their patients. It is a tremendous opportunity to create this enormous ‘beehive of doctors’ who form friendships with their colleagues and learn to adhere to common practices.
Q: How can other physicians participate?
A: Experts can volunteer their time by joining our program and contributing their expertise, which is highly needed. Volunteers are always welcome.
Q: Is there anything else that you would like to mention ?
A: Poverty, corruption and lack of coordination are two of the top reasons for cancer mortality around the world. There are no advocates for patients who are poor. No one is interested in these patients, and they do not have a voice to advocate on their behalf. Cancers grow from delays, and any delays increase cancer stage. Our goal is to change this. – by Jennifer Southall
On the web
To learn more about Global Cancer Institute, go to globalcancerinstitute.org
For more information:
Paul Goss, MD, FRCP, MBBCh, PhD, can be reached at Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.
Disclosure: Goss reports no relevant financial disclosures.