Tumor boards among physicians caring for lung and colorectal cancer patients.

Science of Quality
Session Type and Session Title: 
General Poster Session A: Science of Quality and Cost, Value, and Policy in Quality
Oral Abstract Session: Plenary Abstracts
Abstract Number: 
J Clin Oncol 32, 2014 (suppl 30; abstr 179)
Kenneth L. Kehl, Mary Beth Landrum, Katherine Leslie Kahn, Stacy W. Gray, Clifford Y. Ko, Aileen B. Chen, Nancy Lynn Keating; The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Healh Care Policy, Harvard Medical School, Boston, MA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Dana-Farber Cancer Institute, Boston, MA

Abstract Disclosures


Background: Multidisciplinary tumor board meetings are an important part of cancer care, but few data are available about their benefits. We assessed the association of tumor board participation and structure with patient outcomes. Methods: We surveyed a population and health system-based cohort of patients with lung or colorectal cancer diagnosed in 2003-05 (N=9732) and their physicians (N=1601). We asked physicians how often they participated in tumor boards and whether those meetings served a treatment planning function, evaluated prior treatment decisions, reviewed only challenging cases, reviewed >1 cancer site, and/or served only as teaching sessions. Using logistic and Cox regression, we assessed associations of tumor board participation and tumor board features with patient clinical trial enrollment, receipt of guideline-concordant care, patient-reported quality, and survival. We adjusted for patient demographic and clinical characteristics and physician traits, including specialty. In this exploratory analysis, P values were not adjusted for multiple comparisons. Results: Patients treated by the 54% of physicians participating in tumor boards weekly (vs. less often/never) were more likely to enroll in clinical trials (OR 1.6, 95% CI 1.1-2.2). Patients of physicians whose meetings reviewed >1 cancer site had lower likelihood of trial enrollment (P=0.04) and, among patients with stage I/II non-small cell lung cancer (NSCLC), of curative-intent surgery (P<0.001). Patients with stage I NSCLC, extensive-stage small cell lung cancer (SCLC), or stage IV colorectal cancer had lower mortality if treated by physicians participating in tumor boards weekly (vs. less often/never, P<0.05). Stage I NSCLC patients whose physicians’ tumor boards reviewed >1 cancer site had higher mortality (P=0.04), as did patients with SCLC whose physicians’ tumor boards served only as teaching sessions (P=0.004 for limited SCLC, <0.001 for extensive SCLC). Conclusions: Frequent physician tumor board engagement was associated with patient clinical trial participation and lower mortality for colorectal, small cell lung, and early non-small cell lung cancer, diseases that may benefit from coordinated treatment delivery among specialists.