Abstract
Tumor Boards or Multidisciplinary Cancer Meetings (MCM) are the model of care for the management of cancer patients worldwide. Many neuro-oncology conditions do not have a standard of care regimen. Optimal care for these patients requires a multidisciplinary team approach. Benefits include efficient coordination of multiple providers, direction for complicated cases, open communication amongst care teams, education, and clinical trial access. In most institutions MCMs prospectively coordinate multidisciplinary care and influence care decisions, however the exact impact is unclear. The purpose of this study is to define the role of MCM in neuro-oncology and to identify participants, content, and perceived value.
A cross sectional descriptive online survey design was used to assess participation and utilization patterns of MCMs in Neuro-oncology. 87 centers in the United States were invited to complete an electronic survey. Neuro-oncology centers were identified with the help of the American Brain Tumor Association or due to their participation in the Adult Brain Tumor Consortium, the Brain Tumor Trials Collaborative, or if they are a designated National Cancer Institute center. Surveys were administered utilizing REDCap with 46 respondents (53%).
73% of respondents were neurologists, 13% medical oncologists, and 13% other. 100% of institutions review primary brain tumors, 93% discuss neoplastic spine disease, 89% review metastatic brain lesions and 40% review paraneoplastic conditions. 98% discuss “challenging cases”, 96% review recurrent disease, 82% review undiagnosed or pre-surgical cases. 89% utilize radiology review. 100% of MCMs included Neuro-Oncology, Neurosurgery, and Radiation Oncology representatives. Other participants include radiologists (98%), pathologists (96%), residents and fellows (93%) and other clinical trials representatives (64%). Genetics, Behavioral Health, and Social Work participate at less than 15% of centers. Neuro-Oncology, Neurosurgery, and Radiation Oncology, presented cases at greater than 75% of centers. 76% reviewed Pathology. 80% meet weekly, 36% include satellite centers. Individual preparation time varied from 15 min to 5 hrs. 94% value MCM for clinical decision-making, 89% for education and 69% to determine access to clinical trials. Only 13% document MCM results in their electronic health records. 38% centers use molecular tumor boards, but many institutions commented about uncertainty as to how a molecular tumor board is defined and utilized.
Neuro-oncology MCMs at academic U.S. institutions show high homogeneity of participating members. While there is strong agreement on the role of clinical decision making and education, the implementation of recommendations varies widely. There is high uncertainty as to the definition and implementation of a molecular tumor board in neuro-oncology.