What Happens During a Multidisciplinary Tumor Board?

A tumor board is a scheduled meeting. Doctors from several specialties review patients' cases together and agree on a treatment recommendation. The National Cancer Institute calls it a treatment planning approach, in which experts from different fields review and discuss a patient's medical condition and treatment options. The group usually includes a medical oncologist, a surgical oncologist and a radiation oncologist, among others.

It is one of the few parts of cancer care that really changes how decisions get made. Most patients never hear about it.

The core group:

• Medical oncologist — chemotherapy, immunotherapy, targeted and hormone therapy.
• Surgical oncologist — whether and how the tumor can be removed.
• Radiation oncologist — whether radiation has a role, and in what order.
• Pathologist — puts your slides on screen and walks through what the tissue shows.
• Radiologist — pulls up your scans and reads them again live, comparing them with earlier ones.

Depending on the program, you may also find an oncology nurse navigator, an advanced practice provider, an oncology pharmacist, a genetic counselor, a clinical trial coordinator, a palliative care physician, a social worker, and residents or fellows.

Larger centers run boards for one disease each — breast, thoracic, gastrointestinal, genitourinary, neuro, sarcoma. They often run a separate molecular tumor board too. That one reviews genomic test results and matches gene changes to targeted drugs or trials.

Your treating doctor submits your case in advance. A typical meeting covers eight to fifteen cases in an hour, so each one gets a few minutes.

The presenting doctor gives a short history. Your age, other medical problems, how the cancer was found, and what has been done so far. The radiologist puts up the imaging and states the findings and the stage. The pathologist projects the slides and confirms the diagnosis, grade and biomarkers.

Then the specialists discuss. Can this be removed by surgery? Should drug treatment come first? Is radiation needed? Is there a trial? Is more testing needed before deciding?

The group reaches a recommendation. A coordinator writes it down, and it should end up in your chart.

Two things happen in that room that do not happen in a clinic visit. First, fresh eyes look again at the slides and images. That is why the stage, and sometimes the diagnosis itself, can change. Second, specialists who would otherwise never meet about your case have to settle their differences in front of each other.

Patients do not attend. It is not a hearing, and there is no vote you take part in.

The recommendation is advice, not an order. Your treating doctor stays responsible for your care and makes the final decision with you. They may go a different way for reasons specific to you. Other illnesses, your own goals, or information the group did not have.

Not every case is presented. Programs give priority to new diagnoses, complex or unusual cases, disagreements between specialists, cancers that have come back, and cases where a trial might apply. A straightforward case that follows a clear guideline may never be discussed. That is not neglect.

Ask the question plainly at your next appointment: "Has my case been presented at tumor board? If not, can it be?"

If it has, ask what was recommended. Ask whether anyone disagreed. Ask whether it can be written into your chart so you can read it.

If it has not, and your case is complex, ask for it to be scheduled. Complex might mean an unclear diagnosis, specialists giving you different plans, a rare cancer, or a cancer that has come back. This is a normal request.

If your practice does not hold tumor boards, ask whether it takes part in a regional or virtual one. Or ask whether it can send your case out for outside review. Programs accredited by the Commission on Cancer must hold regular multidisciplinary cancer conferences. That is one practical reason to check accreditation when you choose where to be treated.

Ask why. There is often a good answer. Another illness, a preference of yours, or something learned since the meeting. What you want is the reasoning, not obedience for its own sake. And if you cannot get an explanation you can follow, that is worth noting in itself.

Accreditation standards described here are US-specific.

• ACS — Commission on Cancer accreditation
• NCI — Finding Health Care Services
• NCI — Find NCI-Supported Clinical Trials
• NCI — Pathology Reports