MULTISPECIALTY CLINIC / TUMOR BOARD

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Multispecialty Clinic / Tumor Board

Anesthesiology Services

Overview

Development and approval of newer cancer directed therapies, with targeted therapies and immunotherapy making it to the front, the treatment of cancer has witnessed a new paradigm. It has long been understood as a disease which although has myriad manifestations, but has always been perceived as a single specialty disease viz-a-vis: medical/surgical/radiation oncology. The evolving knowledgebase has led to the realization that no two cancers are same, and each one requires precise treatment options, which may involve any of the specialties alone or more often in combination for optimal patient outcomes. Hence the concept of multispecialty clinics/tumor boards have evolved which help reach consensus right from the diagnosis up to what therapy may be instituted.

Multispecialty Clinics or Tumor Boards are forums for the interdisciplinary care of cancer patients, especially those with difficult management problems or unusual manifestations of cancer. They provide a mechanism for reaching a consensus on treatment through the empirical process of testing our opinions against one another and through facts. The mechanism follows democratic principles, that is, full and equal representation of all views.

Why is it important to have regular Tumor Boards/Multispecialty Clinics?

There are various reasons not only pertaining to the patient in question, but also for clinicians as well as junior clinicians under training.

Patient related : MSC is a forum for pretreatment evaluation, clinicoradiological and clinicopathological correlation of the diagnosis, resolving controversial issues, and involves discussions starting from diagnostics up to rehabilitation after cancer directed therapy/surgery
Good Clinical Practice: It is a good clinical practice to seek second opinions/consult experts in the field, which aid in institution of optimal patient care
Academic: Interdisciplinary participation and discussions on diagnostics, therapeutics as well as follow up outcomes, aids in enhancing existing knowledge among the members, helps in peer review and improving quality of care provided. Didactic lectures related to the case under discussion helps in continued medical education with the most recent updates in the field.
Updates on Clinical Trials: Presentation of rare/controversial cases, including patients with limited resources, MSC also provides an opportunity to discuss ongoing trials which may be of potential benefit to these patients.
Specialty based Clinics: Many institutes including ours holds meeting specific to organ system based specialties including Thoracic, Hematolymphoid, Gastrointestinal, Head and Neck and Genitourinary, Molecular along with a General Tumor Board once weekly. These focused groups comprise specialists who have gained expertise in the aforementioned systems and exchange of idea/views and opinions help in better clinical judgment and management.
Other Benefits a) Unifying Influence Multispecialty Clinic / Tumor Board serves as a unifying influence in medical practice because they bring together the different specialties in the search of optimal treatment for a difficult disease. With its Multidisciplinary representation, no group other than the Multispecialty Clinic / Tumor Board is better prepared to treat the patient who may feel fragmented by the treatment approaches offered by the different medical Specialties. Initial Management Decisions are often critical in determining ultimate outcome. The final decisions on treatment are the responsibility of the primary treating physicians and that the opinions are only recommendations made to the treating physician by the board.
Usually more focused on the disease site specific process, these Multispecialty Clinic / Tumor Board may consider specific technical issues as well as problems in diagnosis and patients management.

Contributions to care

The Multispecialty Clinic / Tumor Board visibly reflects the interest and the dedication of physicians, and others to the care and treatment of patients with cancer.

Multispecialty Clinic / Tumor Board as an Established Institution

Multispecialty Clinic / Tumor Board is an established Institution for cancer patient care. Multispecialty Clinic / Tumor Board benefits the patients, the physicians, the professional non-medical staff, and the institution. Through the Multispecialty Clinc / Tumor Board, physicians can offer the patient most recent advances in all modalities of treatment, which is the only way to ensure maximal response, highest quality of life and survival. More over patient appreciates the concern shown by physicians when their condition is discussed at the Multispecialty Clinic / Tumor Board.

In medicine, it is difficult to resist the pressure of experience as shared through the Multispecialty Clinic / Tumor Board. When all the alternatives have been shifted, convergence of opinion becomes the accepted course of action. What matters is our loyalty to our patients, not our hope of curing all cancers. We converse at the Multispecialty Clinic / Tumor Board to make further conversation unnecessary.

Multispecialty clinic

Multispecialty clinics or more often known as Tumor Boards have been defined by the National Cancer Institute as:

“A treatment planning approach in which a number of doctors who are experts in different specialties (disciplines) review and discuss the medical condition and treatment options of a patient”

In simpler words, it constitutes a group of doctors and other health care providers with different specialties in oncology that meets regularly at the hospital to discuss cancer cases and share knowledge.

Who takes part in a multispecialty clinic/tumor board?

These are regular (weekly/fortnightly: depending on institutional policies) meetings which involve doctors from all oncology specialties. Medical and surgical oncologists, radiation oncologists, diagnosticians including pathologists, radiologists and molecular pathologists, all constitute the board. Depending on the case list under discussion, other specialties may also be called in including internal medicine experts, gastroenterologists, nephrologists, cardiologists etc. Representatives of other healthcare administrators including nursing head and palliative care experts may also be included. A sample constitution of an MSC is depicted herein.