Tumor Boards Extend Survival for Patients with Cancer

Cancer's Diversity and Complexity Make Collaboration Essential

Cancer treatment decisions have become more complex as treatment options have expanded and understanding of cancers' genetic diversity has improved. Genetic investigations have divided cancers into many previously unidentified subtypes. Clinical trials should also remain an option for accessing newer and more effective medicines. These and other factors increase the diversity and complexity of treatment approaches. Multidisciplinary teams, particularly those including highly specialized experts, have become important in this challenging process. A meta-analysis examining how tumor boards affect cancer survival highlights the role of these approaches in treatment.

Tumor Boards May Extend Survival

Journal of the National Cancer Institute published, on January 20, 2023, a meta-analysis finding that patients whose treatment was managed by tumor boards survived longer.

The meta-analysis included 59 studies and 134,287 patients with cancer: 48,467 managed by tumor boards and 85,820 not managed by tumor boards.

Tumor boards included:

• Medical oncologists (58 studies),
• Radiation oncologists (56 studies),
• Radiologists (55 studies),
• Surgeons (55 studies),
• Nurses (19 studies),
• Palliative care physicians (15 studies),
• Nutrition specialists (14 studies) and
• Social workers (14 studies).

Tumor boards met at diagnosis in all studies. In 12 studies, meetings continued throughout treatment.

Patients had colorectal cancer (15 studies), lung cancer (13), head and neck cancers (6), breast cancer (5), esophageal cancer (5), liver cancer (5), pancreatic cancer (4), stomach cancer (2), hematological cancers (2), soft tissue sarcoma (2) or other cancers (5).

The mean proportion receiving systemic treatment was 54% in the tumor board group and 53% in controls. The corresponding mean proportions receiving radiotherapy were 27% and 24%, while those undergoing surgery were 41% and 33%.

Survival Outcomes

Patients whose treatment was managed by tumor boards had longer overall survival than controls. Median overall survival was 30.2 months versus 19 months, respectively (hazard ratio [HR], 0.67; 95% CI, 0.62-0.71).

The mean proportion alive after two years was 56% in the tumor board group and 46% among controls. After five years, the corresponding mean proportions were 56% and 45%.

Tumor board management was associated with improved overall survival in most cancer types, including:

• Hematological cancer, a reduction in the risk of death of 53% (HR, 0.47; 95% CI, 0.30-0.73)
• Hepatocellular (liver) carcinoma, a reduction in the risk of death of 48% (HR, 0.52; 95% CI, 0.42-0.66)
• Esophageal cancer, a reduction in the risk of death of 40% (HR, 0.60; 95% CI, 0.45-0.80)
• Lung cancer, a reduction in the risk of death of 34% (HR, 0.66; 95% CI, 0.59-0.75)
• Breast cancer, a reduction in the risk of death of 32% (HR, 0.68; 95% CI, 0.48-0.94)
• Head and neck cancers, a reduction in the risk of death of 28% (HR, 0.72; 95% CI, 0.57-0.90)
• Pancreatic cancer, a reduction in the risk of death of 24% (HR, 0.76; 95% CI, 0.65-0.91)
• Colorectal cancer, a reduction in the risk of death of 22% (HR, 0.78; 95% CI, 0.70-0.88)
• Other cancers, a reduction in the risk of death of 51% (HR, 0.49; 95% CI, 0.39-0.64).

However, tumor board management was not significantly associated with improved overall survival in stomach cancer (HR, 0.55; 95% CI, 0.26-1.18) or soft tissue sarcoma (HR, 0.33; 95% CI, 0.08-1.35).

A mind map below summarizes how tumor boards extend survival for patients with cancer:

How Do Tumor Boards Improve Survival?

The role of tumor boards in improving overall survival rests on a multidimensional, integrated approach combining the following factors:

• More diverse and comprehensive perspectives
• Fewer human errors
• A coordinated treatment plan
• Collective decision-making
• Communication across disciplines
• A patient-centered approach
• Integration of current knowledge and research
• Psychosocial support