A cancer diagnosis can seem like an immoldable reality. It can leave you feeling absolutely stuck, married to a daunting fate you didn’t choose or a course of action that doesn’t necessarily spell survival. But as Adam Fox, a physician at the Medical University of South Carolina, explains, “Any patient who wants a second opinion should have one in any form they want” — and that’s exactly what cancer tumor board meetings provide in spades.
What is a Tumor Board?
For those wondering what a tumor board is, the largest takeaway is that it’s a gathering of physicians who are fighting on your behalf. At MUSC, these meetings have taken place every Wednesday at noon for more than 20 years. Before the COVID-19 pandemic, the hospital’s multidisciplinary team would meet in person to discuss cancer cases. Today, the tumor board meetings take place virtually, and someone from each discipline of medicine dials into the video call. The board meets roughly for an hour each week, and they discuss anywhere from five to 10 cases.
“We try not to go too much over that,” begins Claudia Miller, the thoracic oncology nurse navigator at MUSC. “Sometimes we can have 12 or 13 [cases], but … you want to be able to provide enough time to have a good discussion regarding the case, so we don’t want to have 30 patients — there’s just no way to do that.”
The main reason why cases are capped is because there can be a lot of ground to cover. Sometimes, a patient needs their images reviewed, which entails radiology looking back at past scans and making sure that everything is stable or not stable. Physicians might also consult the literature or previous cases of theirs in an effort to make a breakthrough. Other times, patients might need help deciding between two avenues of care, which can spark a spirited debate between the present physicians.
What does a Tumor Board evaluate?
As Fox explains, tumor board meetings typically cover the risks and benefits of someone’s options, and these treatment decisions get “pretty heavily debated” as doctors go back and forth stating their case.”Maybe one [person] truly does have more data or is thinking about it in a way that’s maybe more correct, and that gets clarified through discussion,” he says, adding, “We don’t make the decisions for patients; we make them with them.”
At MUSC, the tumor board has been known to deliberate a patient’s case for as long as 25 minutes. While both Miller and Fox clarify that there may never be a “right answer,” as a rule the meetings don’t move on from a case until some sort of action item has been determined. “We may not have their entire future planned out in 25 minutes,” Fox begins, “but at least there’s usually the next step or piece of information we need panned out by then.”
It’s understandable why a patient wouldn’t know what a tumor board is — much less what to expect — as they’re not a mainstream option. There are myriad popular films about going through cancer treatment, some of which go so far as to show the result of mastectomies and the symptoms of chemotherapy, but few, if any, discuss participating in tumor board meetings. MUSC’s efforts can be summed up this way: It’s a team of people fighting on your behalf. Are there egos sometimes? Sure. But patients have nothing to lose by allowing these expert-led teams to look at their health situation from all angles. And tumor boards are more than just simply getting a second opinion because, actually, it’s gaining sometimes dozens of second opinions and fresh eyes simultaneously.
When can Tumor Boards help?
In reflecting on tumor board cases she’s seen over her roughly 20 years at MUSC, Miller recalls a patient who was presenting with findings in the lungs. The situation was perplexing, as they didn’t fit the usual profile for someone with lung cancer despite there clearly being something amiss in that region. Thanks to the tumor board, their case was addressed from all sides and a colon issue was identified — something that wasn’t looked at before that day.
“I think what’s really important is that we’re reviewing all of these patients who generally come in with a CT scan, chest X-ray or some other kind of image, and generally they’re from the outside,” Miller continues. “So our thoracic-dedicated radiologist is reviewing all these outside images and looking at them again from the perspective of how the case is presented. It’s a little more detailed than just, say, some radiologist on the fly, who doesn’t know anything about the patient, looking at the scan with what’s right in front of them and that’s it.”
At the MUSC tumor board meetings, the doctors have the patient’s entire medical history and their provider presents their case and their history. This means the board has a lot more information to go on and more to look for, Miller explains. “Whoever brings that patient really gets whatever advice from all the subspecialities about that patient’s unique situation: what their imaging looks like, what their background is,” Fox adds. “They get this holistic picture of what the next best steps may be for their patient.”
What is the outcome of a Tumor Board?
While patients aren’t actually in attendance for these meetings, they get a detailed recap of what transpired from their physician. Miller says patients have requested to sit in while their case is presented, but these requests have been denied generally in an effort to provide the best care possible. “Some things can be taken out of context I think, and I don’t know that [having patients present] encourages the physicians to be as open and honest,” she says. Fox expands on this, saying these meetings might be too intense for patients to follow or really gain value from attendance.
“When I was first joining these meetings almost three years ago now, it was difficult for me to follow, even as someone who had been in medicine at that time for 10 years,” he begins. “I could only imagine what a patient would experience hearing their case kind of being thrown back and forth in devil’s advocate kind of talk as to what the right choice is, because in a lot of these cases there is no single absolute best choice.”
In general, cases discussed during MUSC’s tumor board meetings are “extremely difficult,” Fox admits. “And in these kinds of cases, maybe there is no one else quite like you in the cancer world that we could ever extrapolate to what we should do. So, the back and forth sometimes could be pretty overwhelming for people who aren’t really intimately involved in knowing the nuances of treating patients with advanced cancers.”
Patients who consult a tumor board can take solace in knowing they’re in expert hands, and that their physician will relay the essential information to them once the meeting has concluded. Miller notes that sometimes patients want to know what the vote was — or what the show of hands was — over a course of action, and this is something physicians are more than happy to provide. “Generally, it’s a phone call afterward saying, ‘OK, we met and this is the recommendation,” she adds.
Who is eligible?
As far as who is eligible for a cancer tumor board, Miller says no one has ever been turned down for MUSC’s meetings. Whether someone is advocating for their case to be heard or their doctor is advocating on their behalf, every case brought to the board will ultimately be discussed by the board. And while most cases are from patients already in MUSC’s care, the hospital also has another virtual tumor board that considers cases from outside the hospital’s network.
“We do occasionally have providers on the outside who want to present a case to our tumor board, so they’ll send in all the information on the patient and either they’ll call in and do it virtually or [someone] will present the patient,” explains Miller. “We do have physicians outside of our multidisciplinary group, like some of Dr. Fox’s colleagues over in general pulmonary or some from other multidisciplinary teams, who will come in and present patients.”
In addition to the board committing to hearing every case, this service is also absolutely free to patients. It’s a “nonbillable item,” Miller clarifies, meaning that the hospital cannot and does not charge patients for taking advantage of this service. “It’s a totally free service to patients,” Fox reiterates, adding, “I would definitely say that if your physician recommends that your case be discussed at a tumor board, you should view that as a very positive thing — it means that your case may not be super straightforward, but that you’re going to get the best options laid out because of that discussion.”
Both Miller and Fox agree that the cancer tumor board is a positive thing for patient care and for continuing the education of the medical staff. “I learn something new every time,” Fox says. “It builds the communication between providers and it gets tough cases 25 eyes a week. I think everyone benefits from it.”
To get in touch with MUSC about their tumor board, you can call 843-792-9300 or visit their website. This isn’t the only hospital that offers a tumor board, though. Some other cancer tumor boards in the United States include the Northwestern Tumor Board in Illinois; the University of California, San Francisco, tumor board; and the Virginia Oncology Associates’ tumor board. While there will inevitably be similarities from tumor board to tumor board, in regard to what’s discussed and who qualifies, it’s best to speak with your physician when wondering what is a tumor board. These boards can offer an avenue of hope as well as an invaluable second opinion, but only you can know what’s the best course of action for you.
