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Tumor boards may add little to VA cancer care

By Andrew M. Seaman

NEW YORK (Reuters Health) - Getting doctors together to discuss the best treatments for cancer patients in U.S. Veterans Affairs hospitals was only linked to a minor improvement in care in a large new study.

Analyzing the records of 138 VA medical centers, researchers found that the presence of a so-called tumor board - a group of cancer treatment experts - only affected seven out of 27 measures of quality and processes in patient care, and not always for the better.

"This does not support the hypothesis that tumor boards are doing a lot to improve care," said Dr. Nancy Keating from Boston's Harvard Medical School and Brigham and Women's Hospital, the study's senior author.

Tumor boards are a standard part of medical care in the U.S. and are generally made up of several different types of doctors, including surgeons and radiation oncologists, who review patients' cases and make recommendations for their treatment.

The study's authors write in the Journal of the National Cancer Institute that previous research found hospitals dedicate about 50 hours per month of their doctors' time to participation in tumor boards.

"It is interesting that despite the fact that tumor boards seem like a good thing and they are so well established, there is so little literature on them," said Keating.

She and her colleagues wanted to know whether tumor boards actually made a difference.

To do that, they linked together information and records from the VA's 138 medical centers on cancer patients treated between 2001 and 2004.

The team found that 75 percent of the medical centers had at least one tumor board that discussed most of the conditions the researchers were interested in: colorectal, lung, prostate, breast and blood cancers.

Then, using established national guidelines, the researchers developed a list of 27 markers for the quality and type of care patients received.

For example, the researchers checked whether patients with stage II or III rectal cancer got the recommended dose of chemotherapy and radiation before surgery to remove the cancer.

Overall, the researchers found the presence of a tumor board was only linked with differences in seven of the 27 markers.

"And some of those seven were actually a situation where the tumor board was associated with worse care," Keating said.

In addition, recommended care for specific types of malignancies, such as blood cell cancers, was more often seen in centers with no tumor board (56 percent) or only a general tumor board (61 percent) than in centers with tumor boards specializing in blood cancers (39 percent).

"This is a little bit off-putting because it challenges the conventional wisdom that tumor boards are a good thing," said Dr. Douglas Blayney, a professor of medicine at the Stanford School of Medicine in California.

"I think the main issue that remains to be answered: Did the recommendations of the tumor boards actually get carried out?" added Blayney, who wrote an editorial accompanying the study.

"We think patients benefit from having their cases reviewed at the outset, but we leave it to the medical system to get acted upon," he said.

Keating said researchers need to do a "deep dive" into tumor boards to find out more. She said they still need to know how the tumor boards are structured, and what types of cases are discussed.

Until then, "I do think that people and centers who are investing time and energy in their tumor boards should really think about how they are structured, and if they're set up in a way to improve patient care," she said.

Blayney told Reuters Health that he doesn't think hospitals should scrap their tumor boards based on these findings, because there are new possibilities with new technology.

"The promise of telemedicine technology makes extra use of academic centers available to patients who may live in rural locations and doctors who are remote from the academic centers," he said.

For example, the rural doctors of a woman with breast cancer can conference with a tumor board that specializes in breast cancer at a large, urban academic center.

"Again it's tapping into the knowledge and experience of a broad range of physicians," Blayney said.

SOURCE: http://bit.ly/UckC33 Journal of the National Cancer Institute, online December 28, 2012.

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