How a Tumor Board Gets You the Right Cancer Treatment
Cancer is a complex, complicated condition. So if you have a cancer diagnosis, you want as many people as possible working together to treat you. That’s why tumor boards exist — to allow practitioners to meet as a team to discuss difficult cancer cases and work out the best way to treat each patient.
Brian Burkey, MD, Vice Chairman of Head and Neck Surgery and Oncology at Cleveland Clinic, answers questions about how a tumor board improves care for people with cancer.
Q: What is the purpose of a tumor board?
A: Most of my patients come into the system through a general practitioner after experiencing hoarseness, a neck mass, or problems swallowing. They are sent to an ENT (a doctor who specializes in conditions of the head and neck) and then to a surgeon who specializes in otolaryngology-head and neck surgery). We operate for many things nowadays, so it could stop there..
But a tumor board is a multidisciplinary team effort. To have one person deciding on a treatment is difficult because they are only looking at it from their viewpoint. There are so many treatments available; the board helps choose the right treatment for each patient.
Q: Who is on a tumor board?
A: Patients are really able to get more personalized care because there are many heads thinking about their care instead of one.
Those who may take part in our group include:
- Ear, nose and throat physicians
- Surgical oncologists
- Reconstructive surgeons
- Medical and radiation oncologists
- Rehabilitative specialists (a speech pathologist, for example)
Q: What kind of cases does the tumor board take?
A: If a case demands discussion and input — like an advanced tumor, an unusual pathology finding or something concerning after surgery — it is best done at the tumor board.
Boards may consider all kinds of tumors, including breast and lung. We have more than 20 different boards, including our head and neck tumor board.
Q: How does the case review process work?
A: We meet weekly for about an hour-and-a-half and look over the cases of anywhere from five to 20 patients.
We provide the history and go over radiology, surgical and pathological findings, medical and social issues that would impact treatment, and current literature and best practices.
We use all of this to determine how we feel it is best to treat each person. We then provide a recommendation, put it in the chart, and the primary contact takes our advice back to the patient. In the end, the patient decides on their own treatment, with input from the medical team.
Q: How might it change the approach to a patient’s care?
- The oncologist may know the patient isn’t a good candidate for chemotherapy.
- The psychologist and nurse may know the patient has no way to get back and forth to radiation treatments.
- Surgeons may recognize they can perform treatment without impacting function too much and it would be a one-and-done visit.
Q: Are there any other benefits of a tumor board?
A: Yes. Over the long term, the entire team on the tumor board learns a lot about different kinds of treatment; advanced knowledge is truly shared. We also have fellows (advanced trainees) who attend meetings because they get a great education outside of their own specialty.
It’s also good for patients to know that there’s a whole group of people working to benefit their care that they don’t see. What is invisible to them is that there are literally a dozen or two practitioners really working collaboratively on their care.