Cancer Center Benefits from Tumor Boards Enabled by Advanced Technology
Lijo Simpson, MD; Anju Mathew, MBA; George Miranda, MHA; NCRA Journal of Registry Management
January 30, 2017
The DeKalb Medical Cancer Center hosts several tumor boards monthly wherein a multidisciplinary panel of more than 50 physicians and cancer team members (medical oncologists, radiation oncologists, surgeons, pathologists, radiologists, and nurse navigators, as well as team members from clinical genetics, palliative care, clinical trials, nutrition, social work, and pastoral services) convene to discuss the care of patients with cancer.
Through this forum, physicians present their cases and gather multiple opinions to draft the right treatment plans for their patients. These tumor boards enable doctors and other caregivers to participate in a group learning exercise of new diagnostic and treatment options, including available investigational treatments. The tumor board has quickly become one of the centerpieces of the cancer program, extending discussions into the realms of surgery, radiation therapy, chemotherapy, immunotherapy, molecular pathology, and clinical trials.
With more than 1,200 new cancer cases diagnosed within the DeKalb Medical system every year, DeKalb Medical runs at least 8 conferences a month across multiple disciplines. The tumor boards also include the subsequent collection of data for reporting to maintain accreditation through the Commission on Cancer of the American College of Surgeons. Two years ago, DeKalb’s cancer conference coordinator decided to retire and the cancer center administration was left having to continue the meetings without increasing budget or staff.
DeKalb Medical decided to turn to a new technology platform, OncoLens, to automate several parts of the process of pulling together a conference. Compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this mobile- and Web-based platform enabled physicians and other care providers to discuss and develop treatment plans for their cancer patients in real time. The platform also supported in-person discussions. Cases would be submitted online at the physician’s or navigator’s convenience. The case would then be immediately routed to all stakeholders such as radiology, pathology, and genetics research for additional data input. This enabled the early involvement of clinical trials, genetics, nutrition, and palliative care services available within the DeKalb Medical network. Finally, the cancer coordinator would assign the cases to the appropriate meetings for discussion, cutting down significantly on the administrative burden. In addition, DeKalb Medical took advantage of the technology to propagate and educate providers on key quality metrics and goals, such as the incorporation of National Comprehensive Cancer Network guidelines or calling out the need to discuss reproductive counseling for female cancer patients, to ensure that the highest standards of care are met during the discussions.
As a result, DeKalb Medical has been able to not only manage their cancer conferences at 10% of their original operational cost, but also to increase the number of cases collected and discussed at each meeting, while evolving the tumor board into a cancer center education platform. A physician no longer has to wait more than a week to present a case, but can now submit a case the day after seeing it, in time to significantly impact the treatment plan. Since implementation, cases reviewed have increased and patients have a better chance of getting their cases discussed through this multidisciplinary approach.
Location, too, is no longer a barrier. Physicians located at the more remote Hillandale campus can now participate in these cancer conferences, enabling providers and patients to have access to all of DeKalb Medical’s expertise.
DeKalb Medical also decided to use the OncoLens platform to improve the management of incidentally found lung nodules on computed tomography scans. Typically, these would have taken several weeks for discussion between the thoracic surgeon, pulmonologists, lung navigators, and radiologists to determine a treatment plan. With the new system, the time frame for presenting and discussing cases has been shortened to 48 hours, which significantly reduces any delay in treatment.
The future of oncology is in precision medicine, which involves using therapies that are unique to an individual’s cancer, based on the specific genetic abnormalities of that patient’s tumor. This requires the implementation of molecular tumor boards, which bring molecular pathologists into the discussion of each patient’s unique cancer. Using new technologies, DeKalb Medical plans to be among the earliest community cancer centers to implement molecular tumor boards.
The tumor board is an integral part of cancer care at several centers across the nation. DeKalb Medical has taken advantage of technology to evolve the tumor board into an educational and quality measurement platform, all at a lower administrative cost.