The Impact of Symptom Severity on Multidisciplinary Tumor Board Treatment Decisions

At the Institute for Oncology and Radiology of Serbia (IORS), the partnership between the supportive care team (SCT) and the multidisciplinary tumor board (MTB) for patients with advanced cancer has progressed. A study was performed to assess symptom load in referred patients and investigate how it relates to MTB treatment decisions.¹

Patients with advanced cancer were referred to the MTB with the option of receiving either anticancer treatment or active symptom control. The SCT used the Edmonton Symptom Assessment System - Revised (ESAS-r) to assess 6 physical symptoms, depression, anxiety, and overall well-being reported by patients upon admission. The link between MTB treatment decision and the individual symptom/overall well-being score (0-10; higher = worse) as well as the composite ESAS-physical and ESAS-total score was investigated.¹

Since November 2018, a total of 136 patients have been referred (median age, 63 years; range, 19-86 years). Gastrointestinal cancer was the most prevalent, followed by genitourinary cancer and lung cancer. The most common reasons for MTB referral were pain (94.1%), reduced well-being (89.7%), and fatigue (77.94%). There was no link between the severity of patients’ symptoms (ESAS-total and physical) and their MTB treatment decision. Although pain, fatigue, and reduced well-being were all reported to be considerable, they were not linked to the MTB treatment decision within the IORS study. Within this study, patients were referred directly by the MTB, which allowed the SCT to get involved early and for patients to disclose their symptom burden. Feedback on patients’ symptom burden from the SCT to the MTB could be utilized to aid therapeutic decision-making and help prioritize treatments for patients with advanced cancer to receive anticancer treatment or active symptom control.¹

Within the IORS study, symptom severity was not linked to MTB treatment decisions. MTBs collaborate closely to make clinical choices in cancer therapy and are expected to improve patient and organizational outcomes. A multidisciplinary approach is the most effective way to provide the complex care that patients with cancer require; however, it is a challenge that requires organizational interventions, as well as the leadership of competent health executives who can improve teamwork within their organizations.² The cornerstone to cancer treatment is multidisciplinary care and data suggest that multidisciplinary care facilitates high-quality cancer treatment, which may lead to increased survival in patients with cancer, their treatment adherence, and improved quality of life.³

References

1. Djordjevic FR, Calamac M, Bosnjak SM, et al. Patients with advanced cancer referred to a supportive care team (SCT) from a multidisciplinary tumor board (MTB): symptom burden and its relationship with MTB treatment decision. Ann Oncol. 2021;32(suppl 5):S1194.
2. Specchia ML, Frisicale EM, Carini E, et al. The impact of tumor board on cancer care: evidence from an umbrella review. BMC Health Serv Res. 2020;20:73.
3. Hardavella G, Frille A, Theochari C, et al. Multidisciplinary care models for patients with lung cancer. Breathe (Sheff). 2020;16:200076.