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Head and Neck Tumor Board (Multidisciplinary Treatment Planning Conference)

last modified on: Wed, 09/06/2017 - 11:29

Head and Neck Tumor Board (Multidisciplinary Treatment Planning Conference)

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  1. GENERAL CONSIDERATIONS
    1. 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.
    2. Focus of Tumor Board (two approaches)
      1. Patient management or "working" conference
        1. All cases are presented
        2. Previously untreated "new" cancer cases
        3. Recurrent cancer cases
        4. Cases suspicious for cancer, in need of further diagnostic steps
        5. Cases treated surgically, for pathologic review to determine the need for postoperative adjuvant therapy
        6. Cases treated non-surgically, to determine the type of response and need for other intervention
        7. 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.
        8. Most of the cases require only minimal discussion, which permits presentation of many cases in a brief period of time.
        9. Interaction is primarily between experienced physicians.
      2. Teaching conference or "fascinating case" conference
        1. Only interesting cases are presented.
        2. Emphasis is placed on discussion of general principles rather than the specifics of an individual case.
        3. Each case receives a detailed discussion, which permits presentation of only a few cases.
        4. Interaction involves presentation of cases and proposal of management plans by medical students or residents with corrections offered by staff physicians.
    3. 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
    4. Head and Neck Tumor Board Participants
      1. Core to all cases
        1. Head and neck surgeons
        2. Radiation oncologists
        3. Diagnostic radiologists
        4. Pathologists
        5. Dental prosthodontics
        6. Medical oncologists
        7. Oncology nurses
        8. Nuclear Medicine radiologists
      2. Involvement with specific cases
        1. Speech pathologists
        2. Social workers
        3. Dietary staff
        4. Other physicians as appropriate for specific cases
        5. Internal medicine physicians
        6. Endocrinologists
        7. Ophthalmologists
        8. Interventional radiologists
        9. Thoracic surgeons
        10. General surgeons
        11. Neurosurgeons
  2. IOWA HEAD AND NECK TUMOR BOARD
    1. 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. The conference now meets every Friday from 6:30 am until 8:00 am. Currently (July, 2009), the tumor board presents between 30 and 40 patients per session. The large number of cases for discussion has spurred development of a separate Thyroid/Endocrine Tumor Board and a Melanoma Tumor Board that meets every other week on Thursday am from 0700 to 0800.
    2. 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 composes a "tumor board note," on the electronic medical record which includes a brief history and physical exam including information about diagnostic studies. The oncology nurses are notified of the tumor board note to add to the list of cases.
      2. A list of cases is completed the Wednesday 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. The physician who composed the tumor board note will update the note prior to tumor board to include the pathology and radiology results if not available at the time of the initial evaluation.
      4. After surgical treatment, the operating resident will compose a follow-up tumor board note for pathology review of the surgical specimen.
    3. Case Presentations (6:30 am Friday)
      1. The oncology nurse distributes a list of tumor board patients to participants.
      2. Cases for pathology review only are presented first, from 6:30 am - 7:00 am, followed by cases with radiology review presented from 7:00 am - 8:00 am. Overflow to 8:30 am is common.
      3. If the resident or medical student involved with the case is in attendance, they are asked to present the case along with a preliminary proposal.
      4. Employing television monitors, participants present the data.
        1. Pertinent x-ray, CT, MRI and/or PET findings (by the radiologist or nuclear medicine radiologist)
        2. Pathology slides (by the pathologist)
        3. Photos (including those from endoscopy (by the head and neck surgeon)
      5. A resident or medical student offers a disposition.
      6. Staff physicians correct the disposition following discussion.
      7. The head and neck fellow or staff physician records the final disposition with alternatives on tumor board notes.
    4. After Tumor Board (Friday or Monday)
      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 final tumor board disposition, and the information is entered into the patient's electronic medical record.
  3. TUMOR BOARD DISPOSITION
    1. 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 caregiver 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.
    2. See attached for a sample tumor board note.
  4. SUGGESTED READING
    1. Gross GE. The role of the tumor board in a community hospital. CA Cancer J Clin. 1987; 37:88-92.
    2. 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.
    3. Muggia FM. Multidisciplinary considerations in cancer treatment: origin and scope. Int J Radiat Oncol Biol Phys. 1984;(suppl 10):31-33.
    4. 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.

      revised 2/97/2009 by AL