Tumor boards are revolutionizing cancer care by bringing your case to a panel of leading experts. Here’s how.

Patient X had cancer. The case was complicated, and the doctor, Temple’s Joseph Friedberg, wanted a second opinion.

So he brought the case to a panel of leading cancer experts from around the world.

The doctors, who meet regularly to review such cases, considered the patient’s medical history, CT scan, biopsy results, and other pertinent health information. Ideas and what-ifs flowed. By the end of the meeting, the group had agreed on the best approach to treatment.

This was one of many times Friedberg paused to reflect on the importance of being part of this international melding of medical minds called a tumor board.

Tumor boards have become a breakthrough way of bringing the best minds, the best data, and the best research to patients with cancer.

We spoke recently with Friedberg, a senior member of the combined lung cancer tumor board at Temple University Hospital and Fox Chase Cancer Center, about tumor boards. His answers below have been edited for clarity.

In the simplest terms, a tumor board is a multi-disciplinary review of a patient’s case. They have become more prevalent over the years, but depending on where you are, your local physician or hospital may not have one.

There’s not a mandate that every cancer be reviewed by a tumor board. Not every patient needs it, at least initially. But the treatment of cancers, and especially lung cancer, has become so multidisciplinary that I would say the majority of patients will wind up getting reviewed.

The surgery really has not changed in many years. How we accomplish the surgery now includes additional options, like robotic surgery, but the specimen is going to look the same if you look at one now versus 20 years ago. On the other hand, there has been a revolution in the medical treatment of these cancers, particularly with the immunotherapies and targeted treatments. The techniques that are used in radiation therapy have significantly improved. The gist is that a computer tells a robot how to deliver the radiation.

But all of this — the sheer number of advances — can also make the treatment decisions more complicated.

For now, our tumor board is conducted via weekly videoconference.

Here’s a hypothetical example — Mr. X has lung cancer, and it looks like the lymph nodes may be involved. It was discovered after a routine screening CT scan. So he gets referred to me, and I present his case at our tumor board. In our board, the smallest number of participants I’ve seen is 40 doctors and nurses, but I’ve also seen as many as 80 people. This might include chest radiologists, pulmonologists, chest pathologists, thoracic surgeons, thoracic oncology nurses, medical oncologists, and radiation oncologists. We might also have social workers, cancer psychiatrists, palliative care doctors, and clergy.

To review Mr. X’s case, I will have prepared by getting the appropriate scans and a pulmonary function test, and in all likelihood, he will have had a biopsy. I’ll present his case — relevant medical details, his history, and things that might make him high-risk for surgery or high-risk for radiation. And then we’ll discuss it. We’ll keep saying, “What if… ? What if …?” It gets complicated.

This is what has been spectacular about our tumor board: I’ve never had this degree of pulmonary medical support. The input from pulmonologists, regarding the management of this aspect of our patients’ care, has been spectacular. We have probably literally 1,000 years of combined experience, looking at the different diseases of the lung. Over the course of my career, cancer has become such a team activity, more and more all the time.

There are still a few straightforward cases. But that’s rarely the case. For a lot of patients, it has become so complicated that this consensus opinion — having people from different disciplines weigh in — is critical.

The patient gets the opinion of a wealth of experts. Without 16 office visits. Without hearing something different from each one of them. Without the delay of waiting for each of the experts to communicate with each other. It’s absolutely better care.

The wealth of expertise can change everything for a patient. It can identify factors that could optimize a patient for surgery, making it safer and easier on the patient. For instance, outside the realm of tumor boards, I’ve never had someone look at the CT scans and say, “This patient should be on this medication before surgery so they can breathe better.” Or, “this person needs to switch to this inhaler for at least two weeks before you do surgery.” But tumor boards, given the breadth of the experts involved, can do this.

They commonly identify aspects of the case that may enable a patient to enroll in a clinical trial, either before surgery or as part of a nonsurgical treatment. Post-operatively, same thing, the tumor board can identify treatment options that are state of the art, whereas if just one oncologist had seen the patient, they might not have known about some of the latest things. One person couldn’t possibly keep up.

The board itself is almost like a 55th opinion. We don’t conclude any discussion without a consensus. All it takes is one person to say, “I wouldn’t do that because …” and then everything comes to a grinding halt. We discuss it. We come up with options.

But if a patient says they want a second opinion, I always encourage them to do that. At the end of the day, you need to be comfortable with your team.

I would like to see increased access, an expansion of the telemedicine aspect. If you’re in rural Nebraska and your local doctor finds a nodule on an X-ray, if you have an iPhone or access to a computer, you could have access to this wealth of expertise and knowledge about the newer and better treatments that are available. This could help confirm the local opinion they received, and they can be comfortable with their decision to stay local. Likewise, they may hear something different from the board and decide it is worth traveling for their care.

More globally, I would like to see more collaboration between centers, especially for the more rare cancers. My specialty is mesothelioma — a few thousand patients a year. I’d like to see collaboration become more of a standard, on a national and international level. Now that videoconferencing is getting so good, we can do that, and it could expedite the advances that we can make.