One of the most powerful tools in cancer treatment today is the tumor board—a group of cancer experts who delve into individual cancer patients’ cases to help them explore their treatment options. As our world increasingly shifts online, virtual tumor boards enable many more patients to benefit from leading experts’ insights. Understanding how tumor boards work could help you get the most out of your own tumor board experience.
What is a tumor board?
A tumor board is a group of physicians and scientists who meet to discuss treatment options for individual cancer patients. Typically, those involved come from different backgrounds, specialties, and expertise, and may include surgeons, radiation oncologists, pathologists, and medical oncologists, so that fresh and differing perspectives can be discussed and knowledge can be shared.
Tumor boards may meet in person, such as at a hospital or cancer center, or they may be conducted virtually. A virtual tumor board can meet via video call or asynchronously via messaging software. Using messaging software, contributors can leave their thoughts on possible options for the patient, and others can comment freely until the deadline for making a final decision of options arises.
Although tumor boards can be held to discuss any type of cancer case, they are usually reserved for patients who have exhausted the standard of care and are seeking new treatment options, as well as those with rare tumor types for which there may not be a standard of care. The hope with both of these types of cases is that the tumor board will bring more knowledge than the treating physician alone may have, along with new and innovative ideas on how to help the patient get the best care possible.
What is the goal of my tumor board?
If your case is selected for a tumor board, everyone involved will meet with the goal of coming up with the best treatment and care plan for you. Among other options, this plan may include standard-of-care treatments, surgery, further testing, off-label therapies, supplements, clinical trials, palliative care, and seeking another opinion. Building the best possible plan for you also takes into account the individualized nature of your case and your goals (such as your ability to travel for a clinical trial, not wanting surgery, or other factors).
What are the benefits of a tumor board?
A tumor board is essentially a “meeting of the minds”—a way for oncologists, scientists, and domain experts to convene and review your case in its entirety. This includes all aspects of your history as related to your cancer, including pathology reports, clinic notes, surgical notes, molecular testing, current and previous treatments, and imaging. It also considers any comorbidities that may be present (diabetes, COPD, and more), as well as current medications and doses (both related to the cancer and medications being prescribed for other reasons). Any natural supplements or natural therapies should also be disclosed.
A tumor board discussing your treatment and care plans means that you will have physicians and scientists—all with varying levels of backgrounds and expertise—meeting with a single goal of coming up with the best possible option(s) for you to move forward.
How does a case review work?
Prior to the actual meeting of a tumor board, those leading the case to be discussed will usually construct your case summary. This will have a timeline of your cancer history, typically starting with the date of cancer diagnosis, and go all of the way through to present day. That timeline will include dates and types of treatments, imaging and its results, and any surgeries. It will also include current medications that are not necessarily related to cancer, as there may be interactions to be aware of. Sometimes this information is depicted in a type of bar chart called a Gantt chart.
Your case summary will also describe any molecular alterations found through molecular profiling (also known as molecular testing). Molecular profiling is critical for finding genetic changes or other pathogenic alterations that could potentially be targeted with specific treatments. This type of testing can be performed on tumor tissue or via liquid biopsy (typically a blood draw). If you have not had molecular profiling performed, and you still have tumor tissue that has been frozen from a prior biopsy available, it can still be done—as long as there is time to wait for the results and a new treatment plan is not needed right away.
Once your case summary is completed, the lead scientist or physician will begin researching options for you. These options can include treatments approved by the U.S Food and Drug Administration (FDA) for treating your cancer type, treatments approved for other cancer types that may target a specific molecular alteration or pathway, investigational therapies not yet approved, surgery, radiation, and chemotherapy. Sometimes an option may be single-agent treatment (one drug on its own), and sometimes it is the combination of multiple avenues, such as two drugs targeting different molecular alterations, a specific drug along with chemotherapy or radiation, or some other combination.
The lead scientist will describe these options and the rationale for them in a brief report that can be distributed with the case summary to those participating prior to the actual tumor board. Once the tumor board meets, the lead scientist will briefly present the case summary and the options report to everyone, and discussion will commence. The end goal of the tumor board is to come to a consensus on what the best next plan of action is for you.
Upon completion of a tumor board and discussion of your case, the lead scientist or physician typically will organize the options into a report, detailing the specific options and how to go about accessing them. This report may be shared with you and your physician. If this report is only shared with you, it is encouraged that you discuss this report with your physician.
How does a tumor board get me the best cancer treatment options?
Not only can a tumor board help determine the best treatment and care plans based on your history and goals, it can also help you implement those plans. If you are seeking another opinion, names can be provided and there may be help setting up an appointment. With regard to treatments and clinical trials, a tumor board can assist your physician with determining eligibility and enrolling in a clinical trial, or obtaining access to a therapy that may not be covered through insurance.
Participants of varying backgrounds who differ in their knowledge base helps to ensure that the tumor board has a good deal of expertise and fresh perspectives, which are crucial to obtaining the best outcome for you. A tumor board, whether it happens in person, via phone, or via chat software, helps the treating physician dive deeper into your case, with the help and knowhow of other physicians and scientists.
How can I get a tumor board to review my case?
Talk to your doctor to find out if your medical provider offers tumor boards and if your case is appropriate for a tumor board review. Or, you can sign up to receive a free treatment options report from Cancer Commons. If your case is particularly challenging, and with your permission, we can organize a virtual tumor board with experts selected from our national network. We will provide you with a report of their reasoning and conclusions, which you can share with your care team to make your final treatment decisions.