Multidisciplinary tumor board analysis: validation study of a central tool in tumor centers

Abstract

The established standard to ensure state-of-the-art cancer treatment is through multidisciplinary tumor boards (TBs), although resource- and time-intensive. In this validation study, the multiple myeloma (MM)-TB was reexamined, aiming to validate our previous (2012–2014) results, now using the TB data from March 2020 to February 2021. We assessed MM-TB protocols, physicians’ documentation, patient, disease, remission status, progression-free survival (PFS), and overall survival (OS) as left-truncated survival times. Moreover, TB-adherence, level of evidence according to grade criteria, time requirements, study inclusion rates, and referral satisfaction were determined. Within a 1-year period, 312 discussed patients were documented in 439 TB protocols. Patient and disease characteristics were typical for comprehensive cancer centers. The percentages of patients discussed at initial diagnosis (ID), with disease recurrence or in need of interdisciplinary advice, were 39%, 28%, and 33%, respectively. Reasons for the MM-TB presentation were therapeutic challenges in 80% or staging/ID-defining questions in 20%. The numbers of presentations were mostly one in 73%, two in 20%, and three or more in 7%. The TB adherence rate was 93%. Reasons for non-adherence were related to patients’ decisions or challenging inclusion criteria for clinical trials. Additionally, we demonstrate that with the initiation of TBs, that the number of interdisciplinarily discussed patients increased, that TB-questions involve advice on the best treatment, and that levels of compliance and evidence can be as high as ≥ 90%. Advantages of TBs are that they may also improve patients’, referrers’, and physicians’ satisfaction, inclusion into clinical trials, and advance interdisciplinary projects, thereby encouraging cancer specialists to engage in them.

Functional cure and long-term survival in multiple myeloma: how to challenge the previously impossible

“…The respective issues are connected to the limited availability of manufacturing slots, the substantial costs and financial toxicities for individuals and health care systems as well as regional and racial disparities when it comes to access to CAR-T cell therapy or other higher-priced therapy options. [56][57][58][59] Even if CAR-T treatments do provide a potentially curative option for MM patients, only a relatively small number of privileged patients in certain regions of the world with well-resourced health care jurisdictions can afford to derive benefit from this important innovation as of now. 56,58,59 Bispecific antibodies represent another novel therapeutic approach that holds significant potential in MM treatment.…”

“…[56][57][58][59] Even if CAR-T treatments do provide a potentially curative option for MM patients, only a relatively small number of privileged patients in certain regions of the world with well-resourced health care jurisdictions can afford to derive benefit from this important innovation as of now. 56,58,59 Bispecific antibodies represent another novel therapeutic approach that holds significant potential in MM treatment. A major advantage compared to CAR T cellular-based therapies include the immediate "off-the-shelf" availability and the broader availability outside tertiary centers, although they remain costly and still require additional hospitalization for step-up dosing that can last several weeks.…”

An overview and a roadmap for artificial intelligence in hematology and oncology

“…The defining feature of such boards is that specialists from different disciplines (e.g., surgery, medical oncology, radiation oncology, radiology, pathology) come together to discuss individual patient cases and make treatment recommendations. The clinical history of a given patient, all available results from diagnostic tests, patient preferences and current medical evidence are integrated in this process (Frank 2022). The level of complexity in clinical decision-making in multidisciplinary tumor boards is increasing with the expanding significance of genomic and molecular data for personalized treatment recommendations in cancer care (Büttner et al 2019;Horak et al 2021).…”

Original Paper Optimizing individualized therapy decision-making in multiple myeloma (MM): Integration and impact of the Revised Myeloma Comorbidity Index in the MM-Tumor Board

“…These patients may also receive triplets or quadruplets, tolerate longer treatment sequences, and should be included in clinical trials. 2,[7][8][9][10][11][12][13] However, inclusion of elderly patients over the age of 70 years and of vulnerable individuals in clinical trials is notably infrequent. Consequently, determining the eligibility of individuals for intensive and/or novel treatment can be challenging.…”

“…Consequently, determining the eligibility of individuals for intensive and/or novel treatment can be challenging. [7][8][9][10][11][12][13][14] To identify suitable treatment options for these patients, functional assessment (FA) tools have been established. 7,8,10,13,14 A FA is a multidimensional, multidisciplinary approach to more objectively determine the functional health status of frail, vulnerable and/or elderly patients.…”