Tumor board is a team endeavor

Group of physicians attend twice-monthly meetings to discuss best course of treatment for breast cancer patients.

By Chris Cunningham

For Register Guard Special Publications

Photo by Collin Andrew

Appeared in print: Friday, Oct. 14, 2011, page E18

At 7 a.m., about 20 physicians viewed the gray-black X-rays and ultrasound images of a woman’s left breast, projected from a powerful digital microscope.

The pathologist operating the equipment, Dr. David Meyers of Pathology Consultants, zoomed in on one image, so everyone in the conference room at Sacred Heart Medical Center at RiverBend could view the patient’s cancerous tumor and lymph nodes inside dense tissue

Called the Breast Cancer Tumor Board, the group assembles twice each month before their official workdays begin, to discuss treatment options for those breast cancer cases that aren’t so straightforward.

As they viewed the images, this multidisciplinary group of radiologists, pathologists, medical oncologists, surgeons and radiation oncologists deliberated over possible treatment courses: Should radiation therapy be given first, or following surgery? What is the expected length of chemotherapy? What are the patient’s wishes? Is other testing needed?

Whenever there are sticking points, the board refers to the National Comprehensive Cancer Network Guidelines for Patients, the most current and comprehensive clinical guidelines for diagnosing and treating people with breast cancer.

Dr. Robert Schauer Dr. Robert Schauer, a surgeon with Northwest Surgical Specialists, discussed his patient, a 64-year-old woman whose yearly mammogram had shown a suspicious shadowing in the right breast.

Shortly after, in a routine office visit, the patient’s primary care physician detected a hard formation, but in the left breast. The patient also had noted the firm, elongated surface in the same breast when she had performed a breast self-examination.

The patient’s follow-up breast ultrasound revealed a small tumor in her left breast. This image of her right breast did not show a tumor.

The patient

Carole Daly, the patient, said she studied the most reliable online material on breast cancer in the days before Schauer performed a sentinel lymph node biopsy, a procedure surgeons use to determine if a cancer has spread from a primary tumor into the lymphatic system.

She says, “In all, seven nodes had cancer, so Dr. Schauer strongly recommended (surgery) to take out the rest of the nodes. They want to get out as much as possible,” says Daly, a development officer at the University of Oregon, who will have had her surgery by the time this article is published.

Schauer told Daly that more than a dozen health professionals on the Breast Cancer Tumor Board would be reviewing her case and making recommendations for her care. Daly was pleased, saying, “if it was just one (physician) making the decision, I would want another opinion.”

Calling herself a pragmatist, Daly approached her upcoming surgery with the efficiency of someone who is a decisive problem solver.”

She even chose the other members of “her (medical) team,” Dr. Joseph Fiorillo, the medical oncologist who will oversee her chemo treatments, and Dr. Julie Gemmell, the radiation oncologist, who will be providing radiation therapy treatments.”

Daly says, with humor, that if the physicians disagreed with Schauer during the tumor board discussion, she was certain “there would be a lively debate.”

Well aware that she could travel to Oregon Health & Science University in Portland or even the Mayo Clinic in Rochester, Minn., for a second opinion, Daly says she believes that in Eugene/Springfield, “I’ve got some of the best doctors and other people weighing in.”

The tumor board

Schauer, who also is chair of this board, kept the ample discussion moving, to ensure there was time in the one-hour conference to cover the other patients whose cases were on the agenda.

Although local physicians have been participating in tumor board conferences for nearly 25 years, Dr. David Fryefield, medical director at Willamette Valley Cancer Institute and Research Center in Eugene, says the single tumor board reorganized three years ago to form eight subspecialty cancer boards, based on the sites on which cancer tumors are found: breast, gastroenterology, gynecology, urology, neuro-oncology, lung, leukemia, and leukemia/lymphoma.

Fryefield says the early tumor board usually discussed cases retrospectively, when patients were well into their treatment, or when a case was academically noteworthy.

But then, cancer treatment was less complex when Fryefield moved to Eugene in 1984. “It used to be that a patient received one kind of treatment or another,” he says.

Since then, cancer care has become increasingly complicated, with patients and their families seeing several medical specialists, in numerous offices and clinics, for a variety of treatment forms, Fryefield says.”

“Today, many patients receive surgery, radiation therapy and chemotherapy,” in sequence or concurrently, a situation that can strain communication among physicians and exhaust patients and families.

“It really felt that we needed a prospective or even real-time approach to treatment,” he says of the new board structure.

The face-to-face interactions on today’s tumor boards represent a well-honed collaboration between Northwest Surgical Specialists, Oregon Imaging Centers, Pathology Consultants, PeaceHealth and Willamette Valley Cancer Institute and Research Center. Most of the specialty boards meet monthly, but some, such as the Breast Cancer Tumor Board, meet twice a month.

“Everyone shows up because they believe the model of interdisciplinary care is best for the patient,” Fryefield says.

So far this year, the physicians participating on the Breast Cancer Tumor Board have contributed 206 hours — for the sole purpose of creating patient plans of care

Daly sums up her feelings about the board by saying, “The more minds, the better.”

Writer Chris Cunningham can be contacted at sp.feedback@registerguard.com..”