Multidisciplinary Tumor Boards Essential for Patients With Renal Cell Carcinoma

A prospective cohort study found the use of a network multidisciplinary tumor board creates the opportunity for discussion of multiple treatment options and clinical trials, and shares the decision-making process with the patients with a high rate of adherence to tumor board recommendations.

The current treatment landscape for localized and metastatic renal cell carcinoma “involves multiple specialists to provide high quality care,” wrote Luna van den Brink, MD, Amsterdam UMC, Netherlands, and coauthors. The use of a multidisciplinary tumor board can result in “tumor staging, evidence-based treatment planning, higher participation in clinical trials, improved communication between physicians of different specialties and improved patient satisfaction.” However, there is a lack of evidence to confirm whether multidisciplinary tumor boards lead to improved clinical outcomes.

This prospective cohort study examined the impact of multidisciplinary tumor boards (including urologists, medical oncologists, interventional radiologists, and radiation oncologists) for patients with renal cell carcinoma, within a Dutch renal cancer network. A total of 2651 discussions between 2017 and 2022 were included in this study, of which 72% (n = 1900) were new patients and 28% (751) were rediscussions. During the tumor board discussions, factors such as comorbidities, tumor stage, pathology, and diagnosis were detailed before the discussion of treatment options. The main end points were distribution of cases presented, proportion of recommendations with multiple treatment options enabling shared decision making, definite treatment following shared decisions making, and adherence to the recommendation of the multidisciplinary tumor board.

A majority of the cases discussed were cT1a/b tumors (46%), and 22% were local recurrences or metachronous metastatic. The rate of adherence to the multidisciplinary tumor board recommendation was 96% and the main reason for nonadherence was patient preference. Of all recommendations, 30% included multiple treatment options which allowed for shared decision making.  Of the cases with cT1a tumors, 45% had multiple treatment options recommended. The most common definite treatments following those recommendations and shared decision making were (cryo)ablation (32%) and active surveillance (30%). The rate of inclusion in clinical trials among patients with cT3/4 tumors was 47%.

Dr Van dan Brink et al concluded, “The inter- ad multidisciplinary aspect of the multidisciplinary tumor board creates opportunity for multiple treatment options and shared decision making with patients, including clinical trials.” The collaborative structure of multidisciplinary tumor boards is “essential” for patients with RCC, due to this disease’s heterogenous and unpredictable nature.

Source:

Van den Brink L, Ruiter AEC, Lagerveld BW, et al. The impact of a multidisciplinary tumor board (MTB) on treatment decision making for patients with renal cell carcinoma (RCC): 5-year data analysis. Clin Genitourin Cancer. Published online February 5, 2024. doi:10.1016/j.clgc.2024.01.021