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.
There are various reasons not only pertaining to the patient in question, but also for clinicians as well as junior clinicians under training.
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 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 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.
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.
All cancer cases belonging to any specialty, any practicing physician is welcome to bring his / her case to Tumor Board for case discussion.