Virtual, Multidisciplinary Lymphoma Tumor Board Impacts Treatment Approaches

According to the National Cancer Institute, a tumor board review is “a treatment-planning approach in which a number of … experts in different disciplines review and discuss the medical condition and treatment options for a patient.” A tumor board’s goal is to determine the best possible treatment and care plan for an individual patient with cancer. Boards can include pathologists, surgeons, medical and radiation oncologists, specialist physicians, and other healthcare providers, including nurses, social workers, and pharmacists.

In to a presentation of study results at the ASH annual meeting, lead author Thomas M. Habermann, MD, of the Division of Hematology at Mayo Clinic in Rochester, Minn., said that “lymphoma-specific tumor board outcomes have not been reported in the molecular era.” He also said that there have not been many reports of multisite, interactive tumor boards using videoconference technology.

The Mayo Clinic group prospectively followed outcomes of their multidisciplinary, multisite lymphoma tumor board that permits in-person attendance in the room at Mayo Clinic, via video conference at a site participating in the international Mayo Clinic Care Network, or via non-participatory live-stream online. The board includes clinical case presentation, presentation of radiology and hematopathology findings, proposed treatment options, review of the literature pertinent to the case, and discussion followed by recommendations. In order to go before the board, a patient must have a diagnosis of lymphoma with pathology reviewed at Mayo Clinic and have active clinical issues or questions to be addressed. Each 60-minute meeting reviews four cases, and 309 highly selected cases were presented from 2014 to 2018.

The researchers evaluated the board’s recommendations for changes in radiological interpretation, pathologic diagnosis, and treatment approaches. Overall, tumor board review resulted in changes in care for 54% of patients:

• Radiologic interpretation was altered in 1.6%.
• Pathologic diagnosis was changed in 8.7%.
• Additional testing was recommended in 14%.
• Changes to clinical management were recommended in 29%.

Among the cases where the board recommended changes to clinical management, 14% involved alterations in treatment approach, 3% involved a change from undecided treatment to the pursuit of treatment, 1.3% resulted in a change from undecided treatment to further diagnostic testing, 3% involved a change from observation to treatment, 1.3% involved a change from treatment to observation, and 0.6% involved a change from treatment to further testing.

Although the researchers could not track non-participatory live-stream attendance, they noted that about two-thirds of participants attended in-room/in-person, and about one-third attended externally. In total, 93% of participants reported that participation improved their knowledge and competence. Not a single participant recommended changes to conference format.

Given participant satisfaction and the 54% rate of changes in care, the authors concluded that the “approach was of value, efficacious, and meaningfully impacted lymphoma patients while substantially enhancing interdisciplinary interactions.” The program has evolved over time to offer credits for continuing medical education, include an in-room microscope, review real-time radiological images, and post selected cases online.