I. GENERAL CONSIDERATIONS

A. Purpose

A regularly scheduled formal meeting between physicians who manage cancer patients is useful to ensure that the highest level of care is maintained. These multidisciplinary treatment planning conferences (tumor boards) may be constructed through one of several approaches.

B. Focus of Tumor Board (2 approaches)

1. Patient management or “working” conference

a. All cases are presented.

(1) Previously untreated “new” cancer cases

(2) Recurrent cancer cases

(3) Cases suspicious for cancer, in need of further diagnostic steps

(4) Cases treated surgically, for pathologic review to determine the need for postoperative adjuvant therapy

(5) Cases treated nonsurgically, to determine the type of response and need for other intervention

b. The emphasis is placed on confirming that all the pertinent data accrued in the patient evaluation are known to the physicians involved in the patient’s care.

c. Most of the cases require only minimal discussion, which permits presentation of many cases in a brief period of time.

d. Interaction is primarily between experienced physicians.

2. Teaching conference or “fascinating case” conference

a. Only interesting cases are presented.

b. Emphasis is placed on discussion of general principles rather than the specifics of an individual case.

c. Each case receives a detailed discussion, which permits presentation of only a few cases.

d. Interaction involves presentation of cases and proposal of management plans by medical students or residents with corrections offered by staff physicians.

C. Goals of the Tumor Board

1. Aggregate all pertinent diagnostic material regarding individual cases to permit review

2. Assign a recommended management plan and offer reasonable alternatives

3. Assign definitive staging

4. Create an interactive environment to foster communication between specialties

5. Teach the participating staff, fellow, and resident physicians

6. Teach medical students

7. Provide a forum whereby second opinions are routinely offered

8. Develop a detailed data base

D. Head and Neck Tumor Board Participants

1. Core to all cases

a. Head and neck surgeons

b. Radiation oncologists

c. Diagnostic radiologists

d. Pathologists

e. Dental prosthodontists

f. Medical oncologist

g. Oncology nurses

2. Involvement with specific cases

a. Speech pathologists

b. Social workers

c. Dietary staff

d. Other physicians as appropriate for specific cases

(1) Internal medicine physicians

(2) Endocrinologists

(3) Ophthalmologists (oculoplastic surgeons)

(4) Interventional radiologists

(5) Thoracic surgeons

(6) General surgeons

(7) Neurosurgeons

II. IOWA HEAD AND NECK TUMOR BOARD

A. The tumor board at the University of Iowa has been consistently run as a combined working and teaching conference since September 1990. In 1998, the board presented an average of 22 cases weekly on Monday mornings between 7:00 am and 8:30 am.

B. Preparation for tumor board is coordinated by the oncology nurse

1. A physician (staff, fellow, or resident) evaluates a patient during the week before the tumor board and dictates a “tumor board note,” which includes a brief history and physical exam including information about diagnostic studies.

2. A list of cases is completed the Friday before tumor board and is circulated to tumor board participants. The list includes diagnostic studies to be reviewed and notifies the pathology and radiology services to accumulate materials.

3. A preview of the radiographic images occurs the Friday afternoon before tumor board wherein the senior resident on the Head and Neck Oncology Service meets with the radiologist to identify important findings.

C. Case Presentations (7:00 Monday am)

1. The oncology nurse distributes printed copies of “tumor board notes” to participants.

2. The resident or medical student involved with the case presents the history and physical exam.

3. Employing television monitors, participants present the data.

a. Pertinent x-ray findings (by the radiologist)

b. Pathology slides (by the pathologist)

c. Photos (by the head and neck surgeon)

d. Videolaryngoscopy (by the speech pathologist or head and neck surgeon)

4. A resident or medical student offers a disposition.

5. Staff physicians correct the disposition following discussion.

6. The head and neck fellow or staff physician records the final disposition with alternatives on tumor board notes.

D. After Tumor Board (Monday evening or Tuesday)

1. The staff or fellow physicians contact individual patients by phone to discuss tumor board findings and arrange final disposition.

2. The physicians correct the typed final tumor board disposition, and the information is entered into the patient’s chart.

III. TUMOR BOARD DISPOSITION

A. The disposition offered by the tumor board is considered a suggestion and most commonly offers a spectrum of management options ranked in descending order of support. There is usually a single physician identified as the primary care giver for each individual case. The tumor board disposition is considered a suggestion to this physician with the understanding that he or she, through closer interaction with the patient, is best suited to individually advise the patient.

B. See attached for a sample tumor board note.

IV. SUGGESTED READING

A. Gross GE. The role of the tumor board in a community hospital. CA Cancer J Clin. 1987; 37:88-92.

B. Hoffman HT, McCulloch TM, Gustin D. Organ preservation therapy for advanced stage laryngeal carcinoma. Otolaryngol Clin North Am Curr Concepts Laryngeal Cancer. 1997;30:113-130.

C. Muggia FM. Multidisciplinary considerations in cancer treatment: origin and scope. Int J Radiat Oncol Biol Phys. 1984;(suppl 10):31-33.

D. Vetto JT, Richert-Boe K, Desler M, DuFrain L, Hagen H. Tumor board formats: “fascinating case” versus “working conference.” J Cancer Educ. 1986;11:84-88.