Meeting News CoveragePerspective

Physician tumor board participation linked to clinical trial enrollment

Patients with lung or colorectal cancers whose physicians attended weekly multidisciplinary tumor board meetings were more likely to enroll in clinical trials, according to study results presented at the ASCO Quality Care Symposium.

“Prior studies have been conflicting with regard to the impact of tumor board meetings on patient care,” researcher Kenneth L. Kehl, a fellow in cancer medicine at The University of Texas MD Anderson Cancer Center, said during a press conference. “Our first objective in this analysis was to characterize overall tumor board participation patterns among physicians caring for recently diagnosed lung and colorectal cancer patients. Secondly, we assessed for associations between tumor boards and patient clinical outcomes, adjusting for as many clinical and demographic confounders as possible to try to isolate the independent effect of tumor boards.”

Kehl and colleagues surveyed 1,601 community- and institution-based physicians about their participation in tumor board meetings — which involve surgeons, medical oncologists and radiation oncologists — and about the purpose and scope of the meetings.

Researchers also surveyed 4,620 of these physicians’ patients with lung or colorectal cancers about their communication with their oncology care providers.

Overall, 96% of physicians reported routine participation in tumor board meetings, and 54% reported weekly participation.

Most meetings (82%) were focused on pre-treatment planning, and 92% included an evaluation of prior treatment decisions. Twelve percent of the meetings included teaching sessions rather than a discussion of individual patient cases.

Results also showed 87% of meetings reviewed a variety of cancer types, and 59% focused only on the physicians’ challenging cases.

Overall, weekly tumor board participation was significantly associated with clinical trial enrollment among patients (OR=1.6; 95% CI, 1.1-2.2).

Patients with stage I to stage II non–small cell lung cancer were more likely to undergo curative-intent surgery if their physicians attended tumor board meetings weekly (P˂.001), but this association did not persist if the tumor boards reviewed a variety of cancer sites.

Patients with extensive-stage small cell lung cancer (SCLC) or stage IV colorectal cancer demonstrated improved survival when their physician participated weekly in tumor board meetings compared with patients whose physicians participated less often (P˂.05). Yet, tumor board meetings that only served as teaching sessions were associated with worse survival in patients with SCLC who had limited (P=.004) or extensive (P˂.001) disease.

However, these survival findings are not definitive, Kehl said.

“By definition, since this is an observational analysis and since we used a statistical model trying to isolate the effect of tumor boards, I think it would be hard to definitively say that these meetings directly impacted survival for these patients,” Kehl said. “This finding merits exploration, but in any analysis like this, you cannot draw a direct cause-and-effect relationship.”

For more information:

Kehl KL. Abstract #179. Scheduled for presentation at: ASCO Quality Care Symposium; Oct. 17-18, 2014; Boston.

Disclosure: The researchers report no relevant financial disclosures.

Patients with lung or colorectal cancers whose physicians attended weekly multidisciplinary tumor board meetings were more likely to enroll in clinical trials, according to study results presented at the ASCO Quality Care Symposium.

“Prior studies have been conflicting with regard to the impact of tumor board meetings on patient care,” researcher Kenneth L. Kehl, a fellow in cancer medicine at The University of Texas MD Anderson Cancer Center, said during a press conference. “Our first objective in this analysis was to characterize overall tumor board participation patterns among physicians caring for recently diagnosed lung and colorectal cancer patients. Secondly, we assessed for associations between tumor boards and patient clinical outcomes, adjusting for as many clinical and demographic confounders as possible to try to isolate the independent effect of tumor boards.”

Kehl and colleagues surveyed 1,601 community- and institution-based physicians about their participation in tumor board meetings — which involve surgeons, medical oncologists and radiation oncologists — and about the purpose and scope of the meetings.

Researchers also surveyed 4,620 of these physicians’ patients with lung or colorectal cancers about their communication with their oncology care providers.

Overall, 96% of physicians reported routine participation in tumor board meetings, and 54% reported weekly participation.

Most meetings (82%) were focused on pre-treatment planning, and 92% included an evaluation of prior treatment decisions. Twelve percent of the meetings included teaching sessions rather than a discussion of individual patient cases.

Results also showed 87% of meetings reviewed a variety of cancer types, and 59% focused only on the physicians’ challenging cases.

Overall, weekly tumor board participation was significantly associated with clinical trial enrollment among patients (OR=1.6; 95% CI, 1.1-2.2).

Patients with stage I to stage II non–small cell lung cancer were more likely to undergo curative-intent surgery if their physicians attended tumor board meetings weekly (P˂.001), but this association did not persist if the tumor boards reviewed a variety of cancer sites.

Patients with extensive-stage small cell lung cancer (SCLC) or stage IV colorectal cancer demonstrated improved survival when their physician participated weekly in tumor board meetings compared with patients whose physicians participated less often (P˂.05). Yet, tumor board meetings that only served as teaching sessions were associated with worse survival in patients with SCLC who had limited (P=.004) or extensive (P˂.001) disease.

However, these survival findings are not definitive, Kehl said.

“By definition, since this is an observational analysis and since we used a statistical model trying to isolate the effect of tumor boards, I think it would be hard to definitively say that these meetings directly impacted survival for these patients,” Kehl said. “This finding merits exploration, but in any analysis like this, you cannot draw a direct cause-and-effect relationship.”

For more information:

Kehl KL. Abstract #179. Scheduled for presentation at: ASCO Quality Care Symposium; Oct. 17-18, 2014; Boston.

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Gregory Masters

    Gregory Masters

    This study supports our belief that good communication and coordination of multidisciplinary cancer care is beneficial for these complex patients. Certainly, there is still room to continue to improve our outcomes and our communication, but I think this study shows that many people are involved with this, and their involvement certainly improves the chances of patients being enrolled in clinical trials which will benefit future patients.

    The American College of Surgeons will require that a program have the existence of some type of multidisciplinary tumor board for accreditation, but rarely would I think that anyone would actually be required to show up. That’s almost universally voluntary. However, physicians do have to accumulate continuing medical education hours, and this is often one of the ways that oncologists, surgeons and other practitioners can get that continuing medical education credit. It’s not specifically required, but there are strong incentives for people to participate.

    Tumor boards are basically an educational tool. It is very difficult to measure outcomes with educational interventions, because you don’t necessarily see a direct patient-to-patient improvement. Many of the people are there discussing these cases and getting other types of education. Most of us, I hope, are trying to do the best for our patients whether or not we make time for a tumor board. It is difficult to measure the impact of this specific intervention, and yet, I think all of us who attend them would agree that we educate ourselves in many ways, and this is a good way for physicians to educate themselves with their colleagues. It’s not the only away, but it is one way we can improve our ability to care for cancer patients.

    • Gregory Masters, MD
    • Director, medical oncology fellowship Medical Oncology Hematology Consultants Chair, ASCO Cancer Communications Committee

    Disclosures: Masters reports no relevant financial disclosures.

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