Comprehensive cancer care is a vast subject, it encompasses prevention, public awareness, early detection, evidence-based treatment, state-of-the-art advances, surveillance, tumour registry, epidemiology, multidisciplinary team (MDT) care, audit outcomes, hospice care, education and research. This series of articles from The Cancer Institute (WIA), Adyar, aims to describe some aspects of comprehensive cancer care practice.
“We would like to highlight that the average outcomes in cancer are much better than what is generally perceived by society,” says E. Hemanth Raj – Vice-Chairman, Cancer Institute (WIA), Adyar. Every cancer patient should be aware of the existence of the service called Tumour Boards or Multidisciplinary Tumour Boards (MTBs) or MDT cancer meetings. This is a service provided to ensure that patients receive evidence-based treatment recommendations by a panel of oncology experts. While the concept of MTB was first mentioned in medical literature in the 70s, it has gained widespread acceptance over the past two decades and has become the gold standard in cancer care worldwide.
Three-step process
To understand MTB and the need for it, let’s rewind and start from the point of cancer diagnosis. To formulate a cancer treatment plan, three prerequisites need to be fulfilled. Firstly, confirmation of cancer diagnosis, this forms the foundation of cancer treatment. This entails sampling tissue (sample may be blood, bone marrow, fluid, tumour tissue etc.) for microscopic examination (biopsy) to confirm if the suspected lesion is benign (not a cancer) or malignant(confirms cancer).
Secondly, we do tests to stage the disease. Depending on the site of cancer, appropriate investigations in the form of scans (CT/MRI/ PET/nuclear medicine scans), X-rays and endoscopy, are performed to map the precise extent of the disease in our body. The staging is denoted as TNM stage (T= Tumour size and extent, N=lymph Nodal involvement, M= Metastasis- spread to distant organs to bone, brain, lungs, liver etc).
Thirdly, there are patient factors; how is the patient’s general (overall health/performance status) condition; can the patient withstand the treatment and what are the patient’s personal preference of treatment (if they are unwilling for a particular form of treatment). Having a round table meeting of oncology experts (physically or virtually) who treat a specific cancer discussing the cancer patient on an individual basis is called MTB meeting. Depending on the hospital, MTBs are either general encompassing all cancers or site specific for each region (head and neck, gastrointestinal, breast, urologic cancer boards etc.).
“In the patient’s best interest, all specialists and post-graduate students at our hospital carve out time to mandatorily attend the weekly meeting. This is also a place where knowledge is imparted and imbibed,” explains Kalpana Balakrishnan, Chief Executive Officer and Medical Director, Cancer Institute.
The methodology to conduct MTB meetings is stringent. Individual patient reports are flashed on a screen for the entire panel of experts to comment and only when the most satisfactory treatment under the circumstances is agreed upon, will the discussion progress to the next patient. Quite often, the situation is complex for each patient, such that it is not easy to adopt a management according to guidelines. “Thus, the collective wisdom of the panel of experts, arriving at a treatment recommendation upon discussion of an individual patient makes the entire process patient-centric and patient-safe,” says Arvind Krishnamurthy, head, Surgical Oncology at Cancer Institute.
“Some patients are undecided and delay treatment commencement for prolonged periods and potentially the cancer may progress in the interim. Hence, when there is time lapse of many months, it is prudent to re-evaluate the disease, prior to MTB discussion and decision should be based on the most recent scans,” according to (Initial please) R. Krishnakumar, who heads nuclear medicine.
Composition of MTB assembly
Every MTB meeting comprises of surgeons, medical and radiation oncologists, oncopathologists, radiologists and nuclear medicine specialists, pain and palliative specialist and allied health specialists (including dieticians, physiotherapists, speech language therapists, and psychologists who have an oncology focus). To sum up, the merits of having MTBs include confirming cancer diagnosis and stage accuracy, improving survival outcomes, facilitating early and appropriate treatment. “It serves an educational purpose for post graduates, helps monitor cancer trends and enables audit of outcomes,” states Alexander John, Senior Radiation Oncologist.
“During MTBs, for cancers that are considered incurable, patients can be recruited to cutting edge clinical trials,” added R. Venkatraman, head of Medical Oncology. Anand Raja, lead, uro-oncology and musculo-skeletal oncology, says: “maintaining tumour board synoptic data meticulously reveals cancer trends and facilitates research,” while V. Venktesh, senior surgical oncologist, explains further: “When we are confronted by complex case scenarios, there is a need for unified treatment plan from specialists with decades of experience. This surpasses conventional textbook learning.”
In summary, MTBs are a confluence of diverse oncology experts collaborating to deliver precision treatment for each patient’s unique presentation. The treatment objective is to balance cure, quality of life, in tandem with scientific treatment advances. The primary objective of MTBs are patients, they are at the heart of decision making.
(Dr. Mahalakshmi R. Shetty is an ENT specialist with the Cancer Institute (WIA), Adyar).
Published – April 03, 2025 11:41 pm IST
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