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Stanford Report, March 8, 2000

'Tackling Cancer': Stanford doctors stage mock tumor board for TV show  

BY KRISTIN WEIDENBACH

On Saturday morning in a local television studio, six physicians from Stanford's Clinical Cancer Center discussed three patient cases in a simulated multidisciplinary cancer clinic. Under the collective gaze of three television cameras, the doctors examined CT scans and histology slides, and debated treatment options for their three make-believe patients.

The doctors were taking part in an innovative new television program that they hope will educate the local community about cancer. Rather than simply lecturing to the audience, the presenters chose to conduct a mock multidisciplinary cancer clinic to give viewers a behind-the-scenes glimpse at how surgeons, radiation therapists and medical oncologists team up to beat cancer.

The program was produced in conjunction with the Mid-Peninsula Access Corporation, which provides public access television to Palo Alto, East Palo Alto, Menlo Park, Atherton and Stanford.

Multidisciplinary cancer clinics -- the formal name for what have colloquially come to be known as tumor boards -- have sprung up in cancer centers all over the world since the concept was pioneered at Stanford in the early 1960s by the late radiation oncologist Henry Kaplan, MD, and Saul Rosenberg, MD, professor emeritus, medical oncology.

"These clinics are most suitable for newly diagnosed patients for whom a multidisciplinary approach is being considered," says Charlotte Jacobs, MD, professor of medicine (oncology), director of the Clinical Cancer Center and the television show's host. "An entire group of faculty members sets aside the time to think in depth about each patient and arrive at the best plan of action."

For a patient newly diagnosed with cancer, establishing a treatment plan can entail a long and frustrating pathway from one doctor to another. From a primary care doctor, the patient could be referred to a specialist and from there to a surgeon, and/or a radiation oncologist for radiation treatment or a medical oncologist for chemotherapy. Then all the specialists need to communicate with one another to formulate the best approach. With tests and X-rays being scheduled in between, the process can take weeks or even months.

At a multidisciplinary cancer clinic dedicated to the care of one region or organ system -- gastrointestinal, head and neck, or breast for example -- doctors from different specialties pool their experience and expertise to decide on an optimal treatment approach for each patient.

When a patient is referred to a tumor board he or she initially meets with one doctor who performs an examination and reviews the family and medical history. All the tumor board doctors then convene behind closed doors where a radiologist will present the patient's CT or MRI scans to the group, and a pathologist will display tissue sections, highlighting abnormal cells and unusual features.

Together, the group then decides upon the best course of treatment. Medical oncologists offer opinions on the probability of chemotherapy being able to kill this patient's cancer and radiation oncologists debate the likelihood that radiation treatment could cure the cancer, while surgeons discuss the possibility of removing the malignant tissue. The group also reviews results published in the medical literature as well as clinical trials in which patients may participate.

The physicians may argue different points of view, but will eventually come to consensus regarding the best treatment for this patient and other alternatives that are available to him or her. In the span of a few hours, a team of specialists brings diverse expertise to bear on each case.

At the conclusion of the tumor board meeting, the initial doctor, perhaps accompanied by a colleague, will meet with the patient and deliver the group's findings. The diagnosis, therapy options and recommendations are presented to the patient and the treatment plan is usually decided upon that day. He or she may choose to begin treatment at Stanford or receive care elsewhere.

The kind of direct communication offered by multidisciplinary clinics saves time and unnecessary stress for the patient in the early days of the cancer diagnosis and decision-making. "The tumor board streamlines the scheduling and helps to just get on with things," said a patient in the breast cancer multidisciplinary clinic. "It happened very quickly for which I was grateful, because the waiting is the worst."

Stanford now has about a dozen tumor boards, specializing in most types of cancer, including breast, gynecologic, liver, thoracic and urologic, head and neck, gastrointestinal and melanoma. Up to 30 doctors and medical students may participate in each weekly meeting, and they will usually review four to 10 cases. "In situations where more than one modality is usual to treat the patient, multidisciplinary clinics offer the most efficient way to determine the best treatment," Jacobs said.

Patient care is the main reason for their existence, but the multidisciplinary clinics are also a "wonderful format for teaching," according to Jacobs. New residents and medical students learn collegiality, in addition to the latest multidisciplinary approaches to cancer care.

The gastrointestinal tumor board was featured in the first episode of "Tackling Cancer." Besides Jacobs, George Fisher, MD, assistant professor of medical oncology; King Li, MD, associate professor of radiology; John Higgins, MD, clinical instructor of pathology; Augusto Bastidas, MD, assistant professor of surgery; and Joseph Poen, MD, associate clinical professor of radiation oncology took part in the taping. Pediatric cancer will be covered in a future episode.

The first show will be broadcast on Cable Co-op channel 6 on March 18 at 9:00 p.m., 20 at 6:30 p.m. and 30 at 9:00 p.m. It will also appear on Cable Co-op channel 77 on March 12 and 19 at 6:05 p.m. SR