Reply by Authors

Abstract

Hijazi et al introduced a virtual tumor board (VTB) format to improve complex renal mass care throughout Michigan. 1 The group utilized an asynchronous email format, recruiting physicians from within MUSIC (Michigan Urological Surgery Improvement Collaborative). After 50 cases, the VTB helped generate treatment plans in 42% of cases and shifted management decisions in another 16%. Notably, the group found increased utilization of active surveillance as primary management strategy.We commend the group for formalizing and studying the impact of a VTB. This was timely, as COVID-19 forced many traditionally in-person forums online. In addition, the use of an established network allowed for assessment of the VTB across the geographical and institutional boundaries of a more typical in-person tumor board (TB). Though this is an excellent start, there are several potential areas for improvement and additional collaboration.Work has been done in other areas of oncology highlighting increased utilization of TBs when the format is shifted from in person to online. 2 We think the virtual, asynchronous format described here may lend itself well to enhancing the ability of isolated practitioners to participate in multidisciplinary discussion. However, the pre-established nature of MUSIC limits the study's generalizability to settings in which physicians are not yet connected. 3 Though the email format maximizes flexibility, the authors highlight the challenge of presenting imaging. Our department has transitioned to live online TBs, which avoid this limitation. One could envision a mixed approach, with an asynchronous forum supplemented by live virtual discussions, perhaps to address the most challenging cases.Finally, most participants in this study were urologists. This may have been influenced by both the forum and the disease, but as this concept is expanded, efforts must be made to encourage participation from all relevant specialties, as cross talk across disciplines is one of the core tenets of modern TBs. 4