WASHU MEDICINE PHYSICIANS (FROM LEFT) DOUGLAS ADKINS, MD; WADE THORSTAD, MD; AND SIDHARTH PURAM, MD, PHD, REVIEW SCANS OF HEAD AND NECK TUMORS DURING A TUMOR BOARD MEETING.
Photography by Gregg Goldmann
BY TIM FOX
A tumor board is made up of a group of physician specialists from a number of medical subspecialties: surgeons, oncologists, radiologists, radiation oncologists, geneticists and other specialists. This team meets regularly to discuss the cases of people with cancer. Siteman Cancer Center, based at Barnes-Jewish Hospital and Washington University School of Medicine, has multiple tumor boards, each one organized around a specific cancer site: breast cancer, for example, as well as prostate cancer and most other types of cancer.
Because a tumor board is by nature multidisciplinary, its members work to achieve a variety of goals. It helps those involved in treating a patient stay abreast of the patient’s condition and the care plan, including any changes. It allows members of the tumor board the opportunity to help ensure everyone receives the same standard of care while also offering personalized treatment.
To learn more about tumor boards—why they exist, how they work and how they benefit patients— I talked with two members of the head and neck tumor board at Siteman Cancer Center. Sidharth Puram, MD, PhD, is a WashU Medicine oncologist specializing in head and neck cancer and is division chief of head and neck surgery. Wade Thorstad, MD, is a WashU Medicine radiation oncologist and chief of the head and neck tumor program. Both doctors treat patients through the recently established Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at Siteman Cancer Center.
Why are most tumor boards only in academic medical centers—those that care for patients while also educating and training the physicians of the future?
Puram: Academic hospitals, including Barnes-Jewish Hospital, have the high volume of patients and diversity of skills needed to unlock the benefits of a tumor board. At Siteman Cancer Center, it’s the combination of the board members’ skills, experience and training across different specialties that gives the board the expertise needed to improve outcomes for patients.
Thorstad: Academic hospitals offer a high level of specialization. For example, a smaller facility might have a radiation oncologist who treats several types of cancer, including head and neck, but because of the combined size of Siteman, WashU Medicine and Barnes-Jewish Hospital, I’m able to focus solely on head and neck cancer. That kind of specialization significantly benefits patients.
What does it mean to standardize care?
Puram: Standardized care ensures that each patient receives excellent care. In other words, one patient shouldn’t receive better care because of who is treating them. The tumor board strives to arrive at a consensus about treatment that maintains our institutions’ high standards and gives every patient equal access to the best treatments available. Because the tumor board team is multidisciplinary, each patient’s treatment plan is personalized, based on the individual characteristics of their tumors.
Thorstad: Members of tumor boards also help establish national standards of care. For example, I contribute to care guidelines for the National Comprehensive Cancer Care Network and the American Radium Society. It’s important that leading cancer centers play a role in establishing national guidelines for cancer treatment to help ensure quality of care for all.
Given the importance of standardized care, how do tumor boards account for a patient’s individual needs?
Puram: A primary benefit of tumor boards is that they provide a comprehensive and individualized view of each patient. When we meet, we start with short presentations that cover a person’s history with the disease, from when they initially noticed symptoms to where they are now. We then move to the results of physical exams and any initial treatment, including imaging and pathology reports. This kind of detailed analysis allows us to harness the benefits of personalized care, in which we offer options that can target the specific characteristics of a patient’s tumors. By the end of this process, all tumor board members have the full story and understand the patient’s unique cancer journey.
Thorstad: That approach gives us a lot of flexibility to tailor our treatment recommendations while adhering to standards and considering the patient’s wishes. For example, I currently am treating a person with larynx cancer. Typical treatment for this type of cancer would include chemotherapy, combined with radiation over a relatively large area of the neck. However, this person also has other health problems that present more risk if the typical treatment plan is used. After considering this person’s unique situation, our tumor board has recommended no chemotherapy and radiation treatment of a smaller area.
THE TUMOR BOARD STRIVES TO ARRIVE AT A CONSENSUS ABOUT TREATMENT THAT MAINTAINS SITEMAN’S HIGH STANDARDS AND GIVES EVERY PATIENT EQUAL ACCESS TO THE BEST TREATMENTS AVAILABLE.
Do patients have to follow the tumor board’s recommendations?
Puram: No. The most common misconception about tumor boards is that they decide a person’s fate. Nothing could be further from the truth.
Our goal is to provide appropriate options for each person to consider, whether those options are working toward a cure or toward improving quality of life. The patient and their family can choose to follow the plan, choose a different plan or choose not to pursue treatment.
Thorstad: I agree. Looking again at the person with larynx cancer: They could have chosen to pursue full treatment, including chemotherapy, despite the risks. In such cases, we talk with the patient and family to review all pros and cons. Then we respect the patient’s wishes.
How do tumor boards advance scientific knowledge?
Puram: Because members of the tumor board are aware of ongoing clinical trials related to cancer, we can consider them as part of a treatment plan, and we can inform patients and other involved physicians of any trials that are relevant to the type of cancer being treated. Should a patient choose, we can direct them to the right trials as efficiently as possible. Our tumor board includes research coordinators who stay abreast of trials, qualifications and eligibility. This is one way we can help people receive the most advanced treatment available.
Thorstad: We can also work with larger-scale collaborative group trials under way around the country. Those trials may be asking important questions that we all want answers to, but participation in them can be a lengthy process. These types of trials can be good options for some of our patients. Others in treatment may be good candidates for trials within our institution, allowing us to provide more nimble and expedient care. And we can identify pilot studies that may become part of larger, national trials with a greater number of participants.
What’s next for tumor boards at Siteman?
Puram: Our new head and neck tumor center is an exciting development. It will elevate the care we provide, further encourage trial participation and improve the patient experience.
Thorstad: Yes, the new center means we can help our patients avoid the logistical challenges of navigating multiple locations for treatment and other appointments. We will also use the collaboration between the center and the tumor board to further improve communication, making treatment even more efficient.