Saturday, December 29, 2012

[36] They are now going after Tumor Boards?

[Keating,Journal of the National Cancer Institute,12, VA Health Systems, Tumor Board, stage-specific recommended care]



tumor Boards and the Quality of cancer care
Nancy L. Keating, Mary Beth Landrum, Elizabeth B. Lamont, Samuel R. Bozeman, Lawrence N. Shulman, Barbara J. McNeil

Manuscript received June 15, 2012; revised October 29, 2012; accepted October 31, 2012.
Correspondence to: Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, Boston, MA 02115 (e-mail:
Background Despite the widespread use of tumor boards, few data on their effects on cancer care exist. We assessed whether 
the presence of a tumor board, either general or cancer specific, was associated with recommended cancer care, 
outcomes, or use in the Veterans Affairs (VA) health system.
Methods We surveyed 138 VA medical centers about the presence of tumor boards and linked cancer registry and administrative data to assess receipt of stage-specific recommended care, survival, or use for patients with colorectal, 
lung, prostate, hematologic, and breast cancers diagnosed in the period from 2001 to 2004 and followed through 
2005. We used multivariable logistic regression to assess associations of tumor boards with the measures, adjusting for patient sociodemographic and clinical characteristics. All statistical tests were two-sided.
Results Most facilities (75%) had at least one tumor board, and many had several cancer-specific tumor boards. Presence 
of a tumor board was associated with only seven of 27 measures assessed (all P < .05), and several associations 
were not in expected directions. Rates of some recommended care (eg, white blood cell growth factors with 
cyclophosphamide, adriamycin, vincristine, and prednisone in diffuse large B-cell lymphoma) were lower in centers with hematologic-specialized tumor boards (39.4%) than in centers with general tumor boards (61.3%) or no 
tumor boards (56.4%; P = .002). Only one of 27 measures was statistically significantly associated with tumor boards after applying a Bonferroni correction for multiple comparisons.
Conclusions We observed little association of multidisciplinary tumor boards with measures of use, quality, or survival. This may reflect no effect or an effect that varies by structural and functional components and participants' expertise.
   J Natl Cancer Inst 

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