The Cancer Registry and the Tumor Board

A Dynamic Duo

Webinar Materials

Q & A Transcript

What is the COC requirement for attendance of designated specialists at the Tumor Board?

It is up to the institution to designate the specialists. One example would be a Liquid Tumor Conference (Myeloma, Leukemia, Lymphoma, etc.) would have little reason to include a surgeon routinely. The specialists should be specific to the kind of conference you are having. Another example would be a Liver Tumor Conference which should include an interventional radiologist because they treat liver tumors fairly routinely. If you review the CoC Standards, there is no specific metric for attendance of individuals. It is this way so the institution can develop their own metric.

What strategies have you used to increase attendance at the Tumor Board?

We have tried changing the date of the conference, changing the time of the conference, and offering CMEs for 1 hour of attendance.  We also offer in room and virtual options for attendance at tumor boards. We include attendance at tumor boards as part of physician credentialing. Academic centers can include program directors in surgery and medical oncology, etc. to talk about the importance of allowing trainees to attend. Chief Nursing Officers can be included to discuss attendance by nurses who are given protected time to attend.

How can I arrange for CE credit at the Tumor Board?

At my facility, this is arranged through the Continuing Medical Education Department.

Should a patient be invited to the Tumor Board where his/her case is being discussed?

In the past, patients were brought to the tumor board to get their medical history, a limited exam and to be able to talk to the patients. I am not advocating for this, but at that time it worked well. I am not aware of any tumor conferences routinely bringing patients to conferences. Patients who were brought to the conference really felt like they were special. Today, with the medical/legal issues we face, it is difficult to bring patients but I would not say you can not.

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If you have specialty-related Tumor Boards, should you still have a general Tumor Board?

It is not mandatory to have a General Tumor Board and is entirely up to the institution. However, it is an advantage to have a General Conference. General conferences can be an opportunity to discuss topics not typically discussed at speciality tumor conferences. For  example, a discussion of comorbidities and how they affect outcomes. If a patient does not fit into a speciality conference the general tumor conference is an open venue to discuss.

Should Tumor Boards continue in a virtual format even after the pandemic?

My opinion is “Yes”. The virtual environment has fostered greater attendance and decreased travel time. A bright spot during the pandemic (if you can find one) has been the use of Telehealth. In my eight hospital network, this has been a great opportunity for specialists on all campuses to participate.

What registry data do you suggest we provide for tumor boards?

Demographics, zip code, distance from institution, prevention data, screening data, number of patients treated per cancer type, staging strategies, and in and out migration.

What happens if not all required physicians are present at the tumor board from a CoC standpoint?

The first six months of 2022 site visits will be virtual. The site visitor will review the PRQ which does note attendance per specialists. If the surgeon attended minimal breast conferences then this would be a problem. It is recommended to talk to Program Administration if this was the situation and explain the requirement for attendance. The CoC allows facilities to document an action plan for increasing participation with the required specialist/physician that is not attending. The action plan should be documented at the time the participation issue arises.

The new CoC Cancer Conference Templates require tracking of elements of discussion that are only as appropriate (such as genetics). How will CoC be able to differentiate between cases that should have had that element discussed but it wasn’t vs cases where it wouldn’t have been appropriate to discuss? The grid isn’t differentiating between these.

The CoC manual cannot address every particular issue. In Breast Conferences, most patients should have a genetics discussion. If they are not having a genetics discussion, it would be important to note this and have a discussion about it at the Cancer Committee meeting. At my facility, I count the case if genetics was discussed and I do not count it if genetics was not discussed. The cancer conference coordinator would be aware of the cases that are applicable for support services, genetics and clinical trials, and guide the group to discuss as appropriate. If one of the elements is forgotten, then our conference leader will ask the group: Are there any clinical trials for this patient; would this patient be eligible for genetics, etc. 

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