Abstract: Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients’ management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients’ management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.
Keywords: multidisciplinary, tumor board, cancer patients, benefits, limitations
Management of cancer patients is becoming a worldwide challenge, due to rapidly changing evidence, new drugs approval, and scientific guideline updates. The introduction of the multidisciplinary approach has helped clinicians meet the growing needs of cancer patients. This can be achieved through multidisciplinary clinics, as breast units, or multidisciplinary tumor boards (MTBs), also known as multidisciplinary meetings. Breast units are working entities organized to ensure patients’ clinical examination, diagnostic procedures, including imaging and biopsies, and therapeutic planning, all in one visit. All these procedures are achieved through the combined efforts of different figures, such as clinical oncologists, radiologists, and surgeons, dealing with breast cancer.1,2
In the National Cancer Institute’s dictionary, a tumor board (or review) is defined as:
A treatment planning approach in which a number of doctors who are experts in different specialties (disciplines) review and discuss the medical condition and treatment options of a patient.3
In a cancer setting, this means that multidisciplinary teams discuss the management of cancer patients on a regular basis to provide them the best care, according to their experience and the latest guidelines. This latter approach is common in the US and accepted also in other countries.
Multidisciplinarity began >50 years ago, as reported in several reviews.4 For example, Milligan et al illustrated different cases of patients, not only cancer patients, discussed in laryngology multidisciplinary settings in the 1920s and reported patient anamnesis, clinical history, all specialists opinions given during discussion, and then a conclusive report, specifying how the patient was treated and his/her condition a few months later.5 O’Brien described his experience during his time at Baylor Hospital from the late 1960s to the early 1970s. Once weekly, medical oncologists, together with radiation oncologists and surgeons, discussed all different types of cancer cases.6 Then, in the 1990s, the multidisciplinary approach took hold in Europe’s clinical practice, as has happened in UK and in Germany. Other countries managed to introduce the multidisciplinary approach later (such as in Belgium, where it became mandatory from 2000).7-–9
Typically, multidisciplinary approaches are thought to be meetings where different specialists converge physically together to discuss several clinical cases. Actually, nowadays virtual meetings are also frequently used, allowing distant physicians to confer with each other and decide the right diagnostic and therapeutic path.10 Sometimes, resident hospital staff do not have access to have all required data to make the right decision for each patient, and thus mini–tumor boards are born with the intent to allow only a few specialists to take part in the discussion.1,11,12
A new variety of MTB is the so-called molecular tumor board. Due to the impact of molecular biology as a tool to support different therapeutic decisions, there was the need to add to the “standard” MTB a series of specialists focused on molecular biology, such as pathologists, oncologists, hematologists, basic scientists, and genetic counselors. In particular, due to the opportunity of using genetic cancer-cell profiling to predict drug sensitivity and resistance, molecular tumor boards provide clinicians with the right decision for each patient, due to their taking into account clinical factors and targetable genetic alterations and their relative weight in influencing patient outcomes.1
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