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Cancer is not one disease. It is group of diseases and can arise anywhere in the body from head to toe. From one site of origin it can be of multiple types, say for example lung cancer can be of multiple types. And then there is the stage of the cancer and the level of fitness of the patient to undergo a particular treatment. To put it in a simple form there are multiple factors when deciding the treatment for cancer and there are various modalities involved in the treatment of each particular type. This makes it necessary that while taking the treatment decisions and making a treatment plan it should be done by a group of doctors well versed in each of these modalities. This group of doctors discussing about the patient, giving their inputs and forming the treatment plan is called tumor board and is the right way of managing any patient with cancer.
In this world of rapidly advancing technology it is not possible for a single individual to keep abreast with all that is happening, and same is the story with cancer specialists or oncologists. Managing any cancer generally requires three kind of cancer specialists; medical oncologists the doctors who are responsible for systemic therapy such as chemotherapy, immunotherapy or targeted therapy, second being surgical oncologists who are primarily responsible for surgery of the cancer and the third being radiation oncologists, they are ones who take care of radiation or radiotherapy when needed. Also, in the management of cancer equally important are pathologists who have reported the biopsy specimen and radiologists who give inputs in regards to the imaging such as CT scan or MRI scans done as part of the work-up. These individuals form the team of doctors which is responsible to managing any cancer and they meet often to discuss each patient which is called tumor board. The purpose of tumor board is to provide best care possible for the patient by taking input from all those who are concerned and responsible for treatment. Each doctor responsible advices according to his or her area of specialty and a final plan is reached upon which is then conveyed to the patient or the family. It includes the way patient would be treated, in terms of whether he will require surgery or chemotherapy or radiotherapy or any two or all three and the sequence of in which these would be used. Each treatment modality advised and in the sequence it is offered has certain benefit otherwise treatment would remain incomplete and chances of recurrence or progression high.
A common misconception that more doctors involved means more treatment is not true. When sitting in a scientific discussion such a tumor board each input has to be backed with clinical evidence of it being helpful and to what degree. The promise of ‘primum non nocere’ (first, do no harm) is to be abided with and each treatment offered has to have more benefit than risks associated with it. The purpose is to provide best care possible and that does not mean giving and recommending more treatment but also by avoiding treatment which may not be necessary. It happens that one treating doctor may overestimate the benefit of the therapy offered by him or her while clinical evidence may not support that notion and it helps discussing management of each patient in the tumor board. So is true vice versa.
Premier cancer institutes such as Tata Memorial Hospital, Mumbai and Max Institute of Cancer Care have cemented the idea of tumor board and made it mandatory for each patient to be discussed in the tumors board before the treatment is finalized. They have gone steps ahead and have formed disease management groups (DMG) for better management of each particular cancer type. Building on the premise that not everyone will be able to know & do everything and it is getting difficult to keep one updated with everything that’s happening in their field, each of the medical, surgical and radiation cancer care specialists have been further given an organ or system to focus on. The result of this foresight have been organ specific disease management groups (DMG) for example breast cancer DMG, thoracic cancer DMG, gastrointestinal (GI) cancers DMG etc. where in the super specialist doctors further focus on only one or two organ systems and are able to know what is to know and deliver best care possible.
For someone with cancer relying on the advice of only one specialist is akin to accepting treatment advice which may carry the risk of being incomplete. It is always better to include all the concerned teams at the start of treatment and have a complete plan moving forward.