Virtual Tumor Board: Benefits, Problems, and Finding Balance in a Postpandemic Future

Abstract

Medicine has traditionally been slow to incorporate evolving technologies into the clinical setting. However , the COVID pandemic necessitated disruptive changes affecting how we interface with our patients. To maintain distance, we rapidly integrated digital tools into everyday practice. To keep each other safe, peer-to-peer meetings predominantly switched to online platforms as well. As society transitions to a post-pandemic future, we have the opportunity to evaluate which elements of our venture into the virtual world we wish to keep and what we should leave behind. The study by Davis et al 1 demonstrates two positive outcomes of virtual implementation for multidisciplinary tumor boards (MTB). When compared with 12 months of in-person MTB, 12 months of online MTB saw physician attendance increase by 46%. There was also a 20% increase in individual patient case presentations. These numbers are impressive, highlighting the impact virtual application can have on certain practices. In addition, the study reviews the various known benefits of MTB in patient outcomes, most notably an association with increased survival. 2,3 It also addresses the availability of oncology specialists, which has been identified as one of the main barriers limiting MTB implementation in practice. 4 Outstanding questions remain; does increased quantity of MTB attendance and case presentation correlate with improved quality of patient outcomes? How should we interpret the data presented in this study, and will the virtual MTB model enhance the quality of cancer care in the same way as in-person MTB? This study was not meant to answer these questions, though it provides a foundation upon which to explore them further. Perhaps, the best argument for virtual implementation in medicine has been increased accessibility. Tele-medicine evolved primarily as a means of improving access to care for patients in geographically isolated and under-resourced areas. 5 Digital technologies allow us to overcome barriers such as time and space when connecting with each other. The same appears to be true of virtual meetings for health care providers. The 46% increase in physician attendance when MTB switched from in-person to online is evidence of this. 1 Furthermore, Davis et al reported anecdotal evidence that this increase was, in part, from more community oncologists attending the MTB of a Comprehensive Cancer Center. Having the ability to log on from wherever you are is a major benefit given our busy schedules and daily commitments. Furthermore, having physicians from different community and rural hospitals virtually participate reduces isolation in decision making and, hopefully, improves patient care in smaller centers. Increased attendance at virtual MTB, however, does not necessarily correlate with increased engagement. Just because someone has logged on does not mean they are actively paying attention, especially if cameras are off. Data outside of medicine suggest that virtual meetings can diminish individual attentiveness compared with in-person gatherings. 6 Several reasons for this have been proposed, including lack of visual and tactile cues inherent in face-to-face interactions, inconsistent function of technology (ie, camera, microphone , etc) and added cognitive demand when staring at a screen for long periods of time. This suggests that increased attendance at online MTB, unfortunately, does not necessarily correlate with increased engagement. There are ways to enforce participation, such as mandating that cameras remain on or tracking participant responses. Depending on the culture of the group, however, these ideas may be welcomed or outright rejected. Davis et al demonstrated that alongside increased attendance, there was increased patient case presentation at virtual MTB. The assumption here is that this would lead to even more positive patient outcomes given the known benefits of MTB. 2 Several process measures have been proposed to assess the effectiveness of MTB discussions, including how often a plan of care is changed, the ability to reach consensus, and the ability to action a plan of care developed in a meeting. 7 Whether these measures were improved by virtual MTB was not evaluated in this study. Furthermore , it was not explained where the additional case presentations came from and which populations benefitted from them. One would hope the added number of cases were from more peripheral centers that would otherwise have limited access to a central MTB. A follow-up study should prove that virtual MTB positively alters patient outcomes in a similar fashion to in-person meetings and not just in large centers but in community and rural hospitals as well. Telemedicine has come a long way in improving access to care for geographically marginalized patients. 3 The same is ASSOCIATED