Tumor boards: What they are, how they work and why they matter

When you’ve been diagnosed with cancer, you want to feel confident that every possible treatment option has been carefully considered.

That’s where tumor boards come in.

Tumor boards are groups of medical professionals that meet regularly to discuss their patients’ cancer diagnoses and decide on the best possible treatment plans.

But who participates in these meetings? How do they work? And, why do they matter when you’re facing cancer treatment? Here’s what you need to know.

Who sits on a tumor board?

The participants on a tumor board can vary between one meeting and the next, as well as by cancer type. But in cancer treatment, a tumor board typically includes:

• Medical oncologists, who prescribe oral and IV medications
• Surgical oncologists, who perform surgical procedures
• Radiation oncologists, who oversee radiation therapies

There may also be diagnostic radiologists, pathologists, interventional radiologists, dietitians, social work counselors, advanced practice providers and physical therapists present, because they all play a significant role in patient care.

When we assess head and neck cancer patients, there may be speech pathologists, swallowing coaches, audiologists, dentists and ophthalmologists, too.

Each member brings a different perspective, so we can consider every aspect of a patient’s care before they start treatment.

How does a tumor board work?

About 50 people attend each meeting of the head and neck tumor board. It takes place weekly, which I think is pretty typical of UT MD Anderson, though others may be scheduled more or less frequently.

At each meeting, doctors present the cases of their new patients to the group, then seek input before finalizing their treatment plans. Attendees weigh the benefits of each treatment option against the risks of the functional issues and side effects they may cause, which can affect quality of life.

Our goal is to try to come up with just the right mix — a plan that balances the goals of treatment with the patient’s personal priorities.

Do all hospitals have a tumor board?

Most oncology practices have a tumor board now, because it’s one of the criteria for accreditation by the National Cancer Institute. But in some facilities, it’s just a box to check. Others use tumor boards only to explore the most complex diagnoses. Still others treat them strictly as teaching opportunities. In those situations, two or three patients might be presented along with any relevant literature, then discussed as an academic exercise.

Here at UT MD Anderson, though, our tumor boards are working conferences, where treatment plans actually get decided. And, in the head and neck tumor board, every single new patient’s case gets reviewed. Learning often happens at these meetings, too, of course. But that’s not their main purpose. The real goal of a tumor board is to come up with an ideal treatment plan for each patient.

Why are tumor boards important?

Research shows that obtaining input from many different specialists — instead of just one — can result in both better treatment plans and improved patient outcomes.

So, even if the best possible option for you is surgery, having non-surgical specialists take a look at your situation can provide everyone involved in your care with a more complete picture, resulting in alternatives that may ultimately yield a better plan for you.

This approach — also known as multidisciplinary care — is something UT MD Anderson has perfected. Other facilities may require you to coordinate your own treatment, seeking appointments with various specialists for their opinions because your doctor only handles one aspect of your care. But if you can’t get in to see those people quickly enough, or there’s a communication breakdown between your care teams, that input can be delayed, or even never happen, resulting in significant gap in care.

Tumor boards don’t depend on you to find additional specialists yourself. Instead, they provide multidisciplinary input that comes to you. It’s one-stop shopping in a coordinated and timely manner.

One of the best things about tumor boards is that even if you don’t personally meet with all of the specialists who weigh in on your case, you will still get the benefit of their experience. The average length of practice is 10 years on our tumor boards here at UT MD Anderson. So, if you’ve got 50 people in a room, that’s roughly 500 years of collective medical experience. And, because our members come from all different backgrounds, they don’t just have different amounts of experience, but different types, too. That’s pretty remarkable.

How do you gauge the strength of a tumor board?

With a truly robust tumor board, the answer is “yes” to each of the following questions.

• Is every new patient’s case discussed?
• Are multiple specialties well-represented?
• Does every participant have an equal voice?

That last question is especially important. Because if one person is clearly dominating the conversation, others may be too intimidated to voice their opinion or disagree. When one person has a very strong presence like that, it negates the tumor board’s entire purpose, which is open and honest discussion.

Fortunately, UT MD Anderson has what I call a “balanced” tumor board environment. That means everybody is an expert in their own right. So, even the youngest, most junior member can voice an opinion as strongly as the most senior, experienced member and still be heard and respected.

How do you gauge the effectiveness of a tumor board?

That’s hard to say, because you can’t give the same patient both the original treatment plan recommended by their doctor and the modified treatment plan recommended by a tumor board to compare the results.

What we have found is that 25% to 30% of our head and neck patients here at UT MD Anderson end up with a different treatment plan as a direct result of having their cases presented at a tumor board. That means 1 out of every 3 or 4 of our patients will have a different — and typically better — treatment plan, because of it.

How often are clinical trials included in a tumor board’s recommendations?

Clinical trials are a very common reason for a change in treatment plan.

After a doctor presents a particular patient’s case, someone else might say, “Hey, I’ve got this clinical trial available that’s looking at the standard of care, plus this new promising treatment. I think your patient might qualify for it. Should we ask them if they’d like to enroll?” And, the presenting doctor will say, “Yes! I didn’t know that trial was even open yet. Let’s talk to them about it.”

So, tumor boards give patients options they might not otherwise have.

Tumor board discussions also benefit UT MD Anderson as a whole. Studies that would normally take five years to complete elsewhere may only take half as long here at UT MD Anderson. This is because we’re able to identify candidates for our clinical trials much more quickly. That advances research by speeding up the rate at which new drugs and processes are tested, so they can become available to more patients who need them.

How is accountability measured in tumor boards?

At UT MD Anderson, we document tumor board recommendations in each patient’s chart. So, we can always go back and see if they are being followed. But the recommendations are not considered binding, so treating physicians can always opt to do something else, if it seems appropriate.

If a physician deviates frequently enough from a tumor board’s recommendations to form a pattern, though, they’ll likely be questioned about it. Not in any punitive sort of way — just to see if better choices exist. They’ll also be asked to share their thought processes and any supporting data so that others can learn from them.

How can I make sure my case is reviewed by a tumor board?

The easiest way is to ask. Before deciding where to seek your cancer treatment, ask the oncologist during your first consultation if your case will be reviewed by a multidisciplinary tumor board before treatment begins. If they say no, then consider seeking your care at a place like UT MD Anderson instead, where tumor board review is often a standard part of treatment planning.

Ehab Hanna, M.D., is a head and neck surgeon who specializes in the treatment of skull base tumors.

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