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

Abstract

PURPOSEThe complexity of lung cancer treatment is rapidly increasing, necessitating the use of multidisciplinary approaches for improving outcomes. Although it is common for institutions to have their own tumor boards, tumor boards connecting several general hospitals, and therefore allowing for more diverse opinions, are not prevalent.MATERIALS AND METHODSA tumor board connecting eight hospitals was formed to discuss patients for whom formulating a treatment strategy was difficult. Physicians and hospital staff accessed a high-security communication line via LiveOn ( Japan Media Systems Corporation, Tokyo, Japan), which is completely isolated from the Internet and password protected, that enables each hospital to share the electronic medical records and images of relevant patients at other hospitals on desktop computers in real time. The lung cancer tumor board began in April 2017 and has since been held every Tuesday evening for 1 hour. Preparatory records containing the age, sex, histology, TNM classification, background, and discussion points for each patient are created before each tumor board meeting. After the tumor board discussion, all conclusions and related articles used in the board are added to the minutes, which are finalized as Microsoft Word files, consolidated, and archived. These files can be retrieved later using key words.RESULTSFrom April 2017 to June 2018, 202 patients were discussed. Although TNM classification was not changed for any patient, diverse opinions led to a change in the proposed strategy for 49 of 202 patients.CONCLUSIONThe multidisciplinary tumor board was useful in obtaining various opinions from the perspectives of different experts. This should be evaluated in a prospective study.

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“…This study adds knowledge about health professionals' experiences of key enabling factors and barriers for national, virtual MDTMs for rare cancers, which is essential for future improvements. Few studies today, have reported on implementation of national MDTMs 8,9 and it is well known that a strategy for implementation is essential for the outcome. 17 Damschroder et al (2009) established the theoretical framework, Consolidated Framework for Implementation Research (CFIR) consisting of five synergetic domains by which implementation is accomplished; the intervention, the inner and outer setting, individual characteristics and process.…”

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“…8 Difficulties related to virtual MDTMs include dysfunctional technology, concerns about confidentiality, coordination challenges between hospitals and limited patient-centeredness. 6,9,10 With the aim to develop and optimize national, virtual MDTMs, we investigated health professionals' experiences of key enabling factors and barriers for national, virtual MDTMs for rare cancers.…”

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“…Virtual MDC has been employed in multiple settings including evaluation of lung cancer, 16,17 hepatocellular carcinoma, 18 breast cancer, 19 GI cancer, 19 malignant hematology, 19 general oncology, 20,21 and head and neck 22 . Utilization of virtual MDC has been associated with improved referral coordination, 20 decreased delays in diagnosis and treatment, 16,18,20 higher frequency of MDT evaluation, 18 and reduced patient 18,20 and provider travel burden 16 .…”

Interdisciplinary multimodality management of stage III nonsmall cell lung cancer

“…Overall, stage III NSCLC is the situation where interdisciplinary management is of upmost importance. There is some evidence for lung cancer in general (including stage III) that a multidisciplinary team improves various aspects of management and probably survival [111][112][113][114][115]. Specifically stage III is examined in a single centre study.…”