Starting a tumor board meeting at a public sector hospital – problems faced and its impact on patient care: A lower middle income country experience

Abstract

Introduction: The importance of tumor board meeting in care or cancer patients cannot be ignored. No dedicated tumor boards are held in any public sector hospital in Lahore. We decided to start a regular tumor board in a public sector hospital in Pakistan. We will discuss the problems faced in conducting these meetings and how they affected patient management. Method(s): Department of Surgery at Lahore General Hospital has started conducting Tumor board meetings on monthly basis since Jan 2017. We share our one year experience of the meetings done and problems faced in conducting those meetings. Result(s): A total of 9 MDT Meetings were conducted in which 26 patients suffering from different malignancies were discussed for a better treatment plan. Patients discussed included 10 pre operative and 16 post operative patients respectively. Specialty wise 12 patients were from colorectal, 09 patients were from Hepatobiliary, 02 patients were suffering from Endocrine tumors, 01 patient with malignancy of neuromuscular origin and 02 with CA Esophagus. The biggest issue faced by us was getting all the departments on board for conducting the meetings. We lack a dedicated oncology department at LGH and had to request involvement of personnel from INMOL for decision making. Unfortunately only 5 out of 9 meetings were attended by an oncologist. Similarly pathologist was present in 8 out of 9 meetings. Radiology and surgery had a 100 attendance at the tumor board meetings. Pathological slides were not available for any patients and discussion was done on the basis of the available report of histopathology only in all of the discussed patients. Radiological images were not available on CDs and had to be discussed on films. 2 out of 20 patients didn't even have films available. Management decisions were unaffected in 17 patients and were changed in 09 patients. Conclusion(s): Although we are faced with multiple problems in conducting tumor board meetings at a public sector hospital regularly but it is mandatory for all cancer patients and we believe that with persistence we can achieve a management goal where all patients presenting with cancer will be discussed and managed through a tumor board meeting.