Veterans Affairs Tumor Boards Do Not Improve Cancer Care or Patient Survival

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(ChemotherapyAdvisor) – Multidisciplinary cancer care committees do not consistently improve the quality or outcomes of cancer care, suggests a study of US Veterans Affairs (VA) medical centers published in the Journal of the National Cancer Institute.

“We observed little association of multidisciplinary tumor boards with measures of use, quality, or survival,” reported a team of researchers led by Nancy L. Keating, MD, MPH, of the Department of Health Care Policy at Harvard Medical School. “This may reflect no effect or an effect that varies by structural and functional components and participants' expertise.”

The analysis of VA cancer registry and administrative data assessed compliance levels for 27 measures of cancer stage–specific recommended care and survival among patients with colorectal, lung, prostate, breast and hematologic cancers diagnosed between the years of 2001 and 2004. Among the 138 VA medical centers included in the study, 75% had at least one tumor board presented.

But researchers found “only a modest association” between the presence of tumor boards and treatment decisions, the researchers found. The likelihood of patients with prostate cancer receiving oral antiandrogen therapy before gonadotropin-releasing hormone agonist therapy for metastatic disease was found to be associated with the presence of tumor boards, the authors reported.

But tumor boards were not associated with improved rates of other measures studied, including adjuvant therapy for colon cancer, chemotherapy and radiation therapy for rectal cancer, chemotherapy or radiation for resected stage IIIA non-small-cell lung cancer patients, or adjuvant androgen deprivation for high-risk prostate cancers treated with radiation.

“Receipt of white blood cell growth factor among patients receiving CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) chemotherapy was highest among patients treated at a center with a general tumor board (61.3%) or no tumor board (56.4%), compared with a hematologic cancer-specific tumor board (39.4%; P=0.002),” they wrote.

The findings suggest that “team huddles” between oncologists, pathologists, surgeons, and other members of cancer care teams may be insufficient for compliance with recommended treatments, particularly in a “large integrated health system” like the VA, commented Douglas W. Blayney, MD, of the Stanford Cancer Institute, Stanford School of Medicine, in Stanford, CA. Smaller studies at single institutions have suggested benefits from tumor boards, he noted.

“Huddles are a necessary but not sufficient feature of high-functioning teams,” he noted. “Execution of the plan is how we get to good outcomes regardless of the brilliance of the plan, talent of the team, or difficulty of the task.”

Patient survival “is the most important outcome measure in cancer care,” he wrote, “The presence of tumor boards did not influence any of these (survival) outcome measures.”

Virtual or telemedicine tumor board meetings similar to the Cure4Kids tele-medicine program “should be explored,” Dr. Blayney suggested, for wider collaboration on patient-specific management decisions and issues.

“Additional research is needed to understand the structure and format of tumor boards that lead to the highest quality care,” the study's coauthors advised.

Abstract

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