A tumor board is an approach to treatment planning. It consists of different cancer specialists who review and discuss a patient's medical condition and the possible treatment options. To learn more about tumor boards and their role in cancer treatment, Cancer.Net talked with Anthony F. Provenzano, MD.

Q: Please describe in more detail what a tumor board is and how patients can access one.

A: Before beginning treatment, a newly diagnosed person with cancer may want to ask the oncologist this question: Will my situation be presented before a multidisciplinary tumor board? The National Cancer Institute defines a tumor board as "a treatment planning approach in which a number of doctors who are experts in different specialties review and discuss the medical condition and treatment options of a patient. In cancer treatment, a tumor board review may include that of a medical oncologist (a doctor who provides cancer treatment with drugs), a surgical oncologist (a doctor who provides cancer treatment with surgery), and a radiation oncologist (a doctor who provides cancer treatment with radiation). It is also called a multidisciplinary opinion." The ultimate goal of the tumor board is to find the best possible treatment plan for a patient.

Tumor boards are found at almost any hospital, including community hospitals. Those hospitals with an approved cancer program must have a functioning cancer committee and active tumor board. Tumor boards do not charge fees for their services.

Q: How is a tumor board regulated?

A: In the United States, the American College of Surgeons is responsible for approving cancer programs. My hospital, like many hospitals, has a committee for cancer care that was recently approved with commendation by the American College of Surgeons. This committee oversees the tumor board, including regular review of the tumor board, its members, the number of patients that are presented each year, and whether there is adequate follow-up of each patient.

Q: What happens during a tumor board presentation?

A: During the tumor board, the facts about the patient and his or her cancer are presented, followed by presentations by members of the diagnostic radiology, medical, radiation, and surgical oncology teams. Members of the pathology team (doctors who specialize in interpreting laboratory tests and evaluate cells, tissues, and organs to diagnose disease) may also be present. Patients do not generally participate in tumor board presentations. The tumor board significantly focuses on a patient's treatment options so that the patient can learn from his or her doctor about the best treatment plans available. In my hospital, we require that all treatment options be cross-referenced against a standard, such as the National Comprehensive Cancer Network (NCCN) guidelines or American Society of Clinical Oncology (ASCO) guidelines, even though they may not exactly apply to every patient.

My experience as the chair of the tumor board and cancer committee has been that the tumor board's diagnostic and treatment recommendation often replaces a second opinion that the patient may seek at a major cancer center. In addition, a tumor board can point a patient in the right direction, especially for complex situations, and may save the time and expense of traveling to another hospital. However, a tumor board does not substitute for a second opinion, and patients who would like to get a second opinion should still consider it.

Ultimately, the physician who presents his or her patient's circumstances to the tumor board can share that information with the patient and develop a suitable treatment plan. Most tumor boards meet every one to two weeks at which time approximately four to five complex situations are discussed. Straightforward ones usually aren't presented. The information from the tumor board is available immediately for the patient.

Q: How is the plan from the tumor board implemented?

A: Once the plan is discussed with the patient and family, someone has to ensure that the plan is carried out. For instance, if a tissue diagnosis is already known, the physician in charge must decide if a second pathology opinion is needed. If the pathology report is straightforward, then the coordinating physician can proceed with diagnostic imaging as part of the more general task of staging (a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body). Then, if surgery is part of the initial treatment, the coordinating physician needs to decide if the surgeon assigned to the patient has enough experience in performing that particular type of surgery. If the patient would be better suited to enter a clinical trial (a research study involving people), the physician must decide if the hospital participates in a cooperative study (a research study performed at multiple cancer centers and medical institutions) that satisfies that need. Otherwise, the patient could be referred elsewhere. Also, we recommend that some patients be followed in subsequent tumor boards to see if they are getting the appropriate diagnostic and therapeutic procedures in a timely fashion.

Q: What are some questions for patients to ask their doctors about tumor boards?

A: Some of the questions include the following:

• How many physicians are on your tumor board, and do they represent the expert opinions one would seek at your hospital?
  
  
• Did my situation bring up widely differing opinions among members of the tumor board?
  
  
• Was a clinical trial suggested?
  
  
• Did the tumor board feel that there was enough information presented at the meeting upon which to draw conclusions regarding treatment?
  
  
• Did anyone recommend that more diagnostic imaging be performed, or that more tissue samples be obtained for analysis?
  
  
• Should I seek a second opinion at a major medical center?
  
  
• How soon should I start treatment?
  
  

Dr. Provenzano is Chief, Medical Oncology, at Lawrence Hospital Center in Bronxville, New York. He is a member of the Cancer.Net Advisory Panel.

More Information

When the Doctor Says Cancer

Seeking a Second Opinion

Find an Oncologist

Questions to Ask Your Doctor

Additional Resources

National Comprehensive Cancer Network

American College of Surgeons: Patient Education