Development of a Virtual Multidisciplinary Lung Cancer Tumor Board in a Community Setting

Abstract

Purpose: Creating an effective platform for multidisciplinary tumor conferences can be challenging in the rural community setting. The Duke Cancer Network created an Internet-based platform for a multidisciplinary conference to enhance the care of patients with lung cancer. This conference incorporates providers from different physical locations within a rural community and affiliated providers from a university-based cancer center 2 hours away. An electronic Web conferencing tool connects providers aurally and visually.Methods: Conferences were set up using a commercially available Web conferencing platform. The video platform provides a secure Web site coupled with a secure teleconference platform to ensure patient confidentiality. Multiple disciplines are invited to participate, including radiology, radiation oncology, thoracic surgery, pathology, and medical oncology. Participants only need telephone access and Internet connection to participate. Results: Patient histories and physicals are presented, and theWeb conferencing platform allows radiologic and histologic images to be reviewed. Treatment plans for patients are discussed, allowing providers to coordinate care among the different subspecialties. Patients who need referral to the affiliated universitybased cancer center for specialized services are identified. Pertinent treatment guidelines and journal articles are reviewed. On average, there are 10 participants with one to two cases presented per session. Conclusion:The use of a Web conferencing platform allows subspecialty providers throughout the community and hours away to discuss lung cancer patient cases. This platform increases convenience for providers, eliminating travel to a central location. Coordination of care for patients requiring multidisciplinary care is facilitated, shortening evaluation time before definitive treatment plan.

Multidisciplinary Lung Cancer Tumor Board Connecting Eight General Hospitals in Japan via a High-Security Communication Line

“…However, the concept of the shared desktop is one of the prominent features of the Web-based tumor board, which is different from previous reports in that the images presented to the board were neither PowerPoint slideshows 11,12 nor snapshots 9 and were also different from the transmission of chest x-rays and CT scans between two hospitals. 13 The shared desktop enabled us to access in real time the original and complete images as well as any other critical information in the electronic medical records of each hospital when needed, which were unavailable by the previously reported methods.…”

<p>Health Professionals’ Views on Key Enabling Factors and Barriers of National Multidisciplinary Team Meetings in Cancer Care: A Qualitative Study</p>

“…These factors are interrelated, and lack of designated time has also in earlier studies been pointed out as a determinant for MDTM attendance. 1,12,[19][20][21][22] The CFIRs domain intervention includes adaption ie, to which degree the intervention can be adjusted to meet local needs, but also emphasize the importance of a balance between fulfilling the implementation and flexibility related to local needs, 18 such as adaption to different working schedules. This emphasize the need of, at an early implementation state, clarify the value of participation in MDTM to motivate health professionals in investing the time and effort needed.…”

Telehealth allows for clinical trial participation and multimodality therapy in a rural patient with stage 4 non-small cell lung cancer

“…31 Stevenson et al discuss the implementation of a virtual tumor board at Duke University for the treatment of their lung cancer patients, 85% of which receive their care in community cancer centers. 19 They encountered many of the same initial challenges our institution faced in establishing such a conference for telemedicine, including technological hurdles in connecting multiple cancer centers. Once the system was well established, buy-in from providers in multiple disciplines and medical centers helped bolster the conference as a staple in the treatment of their complex lung cancer patients.…”

“…16–18 Initial studies from multiple institutions have demonstrated that patient discussion in multidisciplinary video tumor boards improves patient satisfaction, provides more patients access to definitive surgical care, and does not significantly delay oncologic therapies. 16,17,19,20 However, these data are limited in an era where more and more institutions are using telemedicine to facilitate the care of these advanced stage cancer patients. 21 …”