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Participation in molecular tumor board may help patients feel better informed, engaged
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Patients with cancer who attended a molecular tumor board meeting reported higher levels of satisfaction afterward, according to study results presented at this year’s ASCO Annual Meeting.
Researchers noted that these patients appeared to have a better sense of engagement in the shared decision-making of their treatment, even if they could not comprehend the genomic information.
“Potential next steps in studying this issue would include sampling a larger patient population and a formal evaluation of the physicians’ experience with patients attending, as well as a more in-depth analysis of how this process affected patients and their families,” Donald L. Trump, MD, FACP, FASCO, CEO emeritus of the Inova Schar Cancer Institute, professor of medicine at University of Virginia Cancer Center and a HemOnc Today Editorial Board Member, said during an interview.
Trump and colleagues sought to assess the feasibility of patient attendance and satisfaction among patients who attended a weekly molecular tumor board meeting at Inova Schar Cancer Institute, which aims to match comprehensive genomic sequencing results with targeted therapies for patients.
Between August 2017 and October 2018, 20 patients attended a molecular tumor board meeting and completed pre-and post-meeting surveys.
All patients reported that it was beneficial to attend, although many expressed concerns about their difficulty understanding the technical aspects of the meeting.
HemOnc Today spoke with Trump about the study results, how they might be perceived and the challenges of incorporating patients into the meetings.
Question: What prompted this research?
Answer: Better-informed patients and families have a better overall experience in tough situations, such as cancer treatment. As the concept of establishing a molecular tumor board came together at Inova Schar Cancer Institute, there was uniform enthusiasm among my colleagues about engaging patients and families in the board meetings, recognizing that it was not going to be an easy proposition due to scheduling and logistical issues.
Q: How did you conduct the research?
A: During the course of just over 1 year, we set out to offer patients and families the opportunity to attend a molecular tumor board meeting, and several were interested. The meeting was audioconferenced across the Inova Schar Cancer Institute system and patients’ identities were not disclosed. Patients were only present during their particular case.
Q: What did you find ?
A: Because of the small sample size, our conclusions were at best preliminary, but we did find through a series of questionnaires that patients and families felt more informed about the overall process than they had at the beginning, and this difference was significant (P = .016). That should not have been a surprise, but it was gratifying to see given the complexity of the material. Among the 20-plus patients and family members, there was a statistically significant increase in knowledge gained, and I would argue that this would be associated with satisfaction and a better overall experience for patients and families.
Q: How might the study results be perceived?
A: One could argue that the sample was so small and the findings so unsurprising that this is more work than is justified, given the incremental improvement in patient or family understanding. It is hard to quantitatively argue against that perception unless we start with a supposition, which I think is well-founded, that individuals who are better informed about their situation are going to be in a better position to make better decisions and will have a better experience in difficult clinical situations. One also could argue that this is feasible and not inordinately complicated, although I think we can do better in making molecular tumor board meeting data understandable for patients and families, as well as for the medical professionals engaged in these conferences. Ultimately, scientific pursuit of this investigation could involve randomization to attendance or no attendance and pre- and post-analysis of satisfaction, overall understanding and feelings of engagement among patients and families.
Q: What are the limitations and challenges of such a practice?
A: Challenges we encountered included coordinating patients’ availability and schedules with the tumor board and overall accrual. Another challenge was to ensure that we provided information to patients in an understandable manner. Tim L. Cannon, MD, clinical director and moderator of the weekly molecular tumor board at Inova Schar Cancer Institute, along with the coordinator of our program and often our genetics counselors set aside time after the formal meeting to engage with patients and explain in detail what we were talking about. Logistics and providing understandable information are probably the biggest challenges, but they are surmountable. If we can integrate such programs into the workflow of our busy clinical lives, the better off our patients will be.
Q: Are there plans for additional research on this topic?
A: We plan to continue this project and to refine it. This is clearly part of the overall package that the cancer institute is seeking to put in place to continue to improve patient experience and patient education. – by Jennifer Southall
Reference:
Cannon TL, et al. Abstract e18001. Presented at: ASCO Annual Meeting; May 31-June 4, 2019; Chicago.
For more information:
Donald L. Trump, MD, can be reached at University of Virginia Cancer Center, 1222 Jefferson Park Ave., Ste. 6171, Charlottesville, VA 22903; email: skip2dornoch1@gmail.com.
Disclosure: Trump reports serving on the advisory board for IBM Watson Cancer, as a consultant for Patient Resource and Cancer Expert Now, and on the data and safety monitoring boards for Bristol-Myers Squibb and Realist Pharma. The study was supported by philanthropic funds from Inova Schar Cancer Institute.