Multidisciplinary tumor boards and their analyses: the yin and yang of outcome measures

Abstract

Background The standard to ensure utmost cancer treatment is a prerequisite in national cancer plans for comprehensive cancer centers (CCCs) and ensured through multidisciplinary tumor boards (MTBs). Despite these being compulsory for CCCs, various analyses on MTBs have been performed, since MTBs are resource-intensive. Outcome measures in these prior analyses had been survival (OS), MTB-adherence and -satisfaction, inclusion of patients into clinical trials and better cancer care. Main body A publication from Freytag et al. performed an analysis in multiple tumor entities and assessed the effect of number of MTBs. By matched-pair analysis, they compared response and OS of patients, whose cases were discussed in MTBs vs. those that were not. The analysis included 454 patients and 66 different tumor types. Only patients with > 3 MTBs showed a significantly better OS than patients with no MTB meeting. Response to treatment, relapse free survival and time to progression were not found to be better, nor was there any difference for a specific tumor entity with vs. without MTB discussions. An in-depth discussion of these results, with respect to the literature (PubMed search: “MTBs AND cancer”) and within the author group, including statisticians specialized in data analysis of cancer patients and questions addressed in MTBs, was performed to interpret these findings. We conclude that the results by Freytag et al. are deceiving due to an “immortal time bias” that requires more careful data interpretation. Conclusions The result of Freytag et al. of a seemingly positive impact of higher number of MTBs needs to be interpreted cautiously: their presumed better OS in patients with > 3 MTB discussions is misleading, due to an immortal time bias. Here patients need to survive long enough to be discussed more often. Therefore, these results should not lead to the conclusion that more MTBs will “automatically” increase cancer patients’ OS, rather than that the insightful discussion, at best in MTBs and with statisticians, will generate meaningful advice, that is important for cancer patients.

Choosing the Right Therapy for Patients with Relapsed/Refractory Multiple Myeloma (RRMM) in Consideration of Patient-, Disease- and Treatment-Related Factors

“…Nevertheless, in RRMM, any fitness assessment is even more important, because numerous relapse regimens exist and their selection is relevant to perform wisely, at best knowing the exact therapy endurance of an MM patient beforehand. Therefore, it is important to assess frailty and comorbidities over the disease course in MM tumor boards regularly and if new treatment decisions are being undertaken [6,[44][45][46][47][48]. The assessment of changing performance status over the disease course was described by us in a reference AL-amyloidosis patient [46], in allogeneic stem cell transplantation-receiving MM patients [47], likewise in ASCT-receiving MM patients [48] and with use of quality of life (QoL) tests in various relapse phases [49].…”

“…Within the last decades, many new drugs and various combinations have been approved for RRMM, and the decision that which therapy might be best for each individual patient has become more complex. Regarding this complexity, interdisciplinary conferences such as tumor boards are an important tool to ensure state-of-the-art antimyeloma treatment and to discuss individualized therapeutic approaches for symptomatic patients involving experts such as radiation therapists, orthopedists, radiologists, nephrologists, pathologists and specialists in molecular diagnostics [6,45].…”

“…Since most myeloma patients suffer from osteolytic lesions, bisphosphonates or denosumab should be administered regularly [91]. Medical care of myeloma patients with skeletal lesions should include close collaboration with radiologists, orthopedists and radiation oncologists [6,45,[91][92][93][94].…”

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

“…Since treatment options for tumor diseases, including multiple myeloma (MM), have improved considerably in recent years [7], cancer care has become more complex due to numerous therapeutic options. In addition, MM patients, with symptomatic disease and SLIM-CRAB criteria (≥ 60% clonal bone marrow plasma cells, involved/uninvolved free light chain (FLC) ratio of ≥ 100, MRI with > 1 focal lesion, hypercalcemia, renal insufficiency, anemia, osteolytic bone lesions), are often treated by different disciplines and require multidisciplinary care to coordinate complex therapeutic options [1,[8][9][10]. TBs represent an established way to meet this goal [1,[8][9][10].…”

“…In addition, MM patients, with symptomatic disease and SLIM-CRAB criteria (≥ 60% clonal bone marrow plasma cells, involved/uninvolved free light chain (FLC) ratio of ≥ 100, MRI with > 1 focal lesion, hypercalcemia, renal insufficiency, anemia, osteolytic bone lesions), are often treated by different disciplines and require multidisciplinary care to coordinate complex therapeutic options [1,[8][9][10]. TBs represent an established way to meet this goal [1,[8][9][10]. Notably, comprehensive TB analyses of other tumor entities have demonstrated efficient treatment decisions and adjustments of initial treatment plans in ~ 30% [2,3,[11][12][13][14][15][16][17].…”