During the Triological Society session “Tumor Board: Multidisciplinary Care of Head and Neck Cancer Patients,” veterans of the head and neck cancer field discussed how they use tumor boards, a treatment planning approach that involves experts from multiple specialties who review and discuss the condition and management options of a patient.
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June 2015The panelists focused on how the approach has helped improve care quality and increased the value of care provided at their respective centers.
Tumor Board Value
Randal Weber, MD, chair of head and neck surgery at the University of Texas MD Anderson Cancer Center in Houston, discussed how his center is examining its own multidisciplinary tumor care to make sure it is providing value to patients.
Value, he reminded the audience, can be seen as a simple calculation proposed by Harvard economist Michael Porter, PhD: outcome divided by the cost of care.
An important metric to look at, Dr. Weber said, is “treatment package time”—the time between surgery or the start of radiation-chemotherapy and the final treatment. A 2002 study concluded that, in cases involving multi-modality therapy, treatment that extends beyond 100 days can have a negative effect on prognosis and survival (Head Neck. 2002;24:115-126). “These are the types of metrics that we try to capture to make sure that we are delivering care efficiently and within the prescribed treatment time,” Dr. Weber said.
They’ve also looked at performance indicators, divided into high-acuity and low-acuity cases—numbers such as hospital stays of two or more days for low-acuity cases and more than 11 days for high-acuity, blood use, and readmissions within 30 days. MD Anderson presented each of its surgeons with their own numbers in these types of categories and, anonymously, with those of their peers.
A year later, when the hospital examined those numbers again, they’d improved—often significantly—or at least had not gotten worse. One finding was that even though metrics such as length of stay and return to the operating room improved, blood use increased. The center is now conducting research to determine the reasons for that increase.
When it comes to cost, the main drivers are the treatment modalities and co-morbid conditions, not disease site or stage, Dr. Weber said. “You have to know your cost of care before you can enter into a bundled payment scheme, and you have to maintain a reasonable margin because if there’s no margin, there’s no mission,” he said. MD Anderson has built in a stop-loss on cases that are extreme outliers, he said.
Palliative Care Specialists
Jonas Johnson, MD, professor and chair of otolaryngology at the University of Pittsburgh School of Medicine, made powerful remarks on acknowledging when patients may have hit the end of the line with aggressive treatment. In those cases, having a palliative care representative on a tumor board is immensely helpful, he said.