M. Shaaban1, H. Zahid1, R. Price1, K. Brownson1 1University of Utah, Center For Global Surgery, Salt Lake City, UT, USA
Introduction: In high-income countries, multidisciplinary tumor boards (MTBs) enhance oncology care through collaborative treatment plans developed by various specialties. Four years ago, our group established a virtual international breast cancer MTB in Mongolia, a low- and middle- income country, as a novel approach to breast cancer care. We aim to optimize the MTB by evaluating multidisciplinary representation, clinical staging accuracy, and acceptance of MTB recommendations.
Methods: Two breast cancer centers in the US and one in Mongolia collaborated via a virtual MTB held monthly over Zoom. The Mongolian team presented de-identified breast cancer patients. Over 6 months, 5 MTBs were conducted, presenting 10 unique patient cases. Attendance was recorded by specialty to evaluate multidisciplinary representation. Clinical staging documented by our Mongolian colleagues was reviewed and updated as needed via group review of patient exams, photos, and imaging studies. Data was collected at least two months after each MTB to investigate incorporation of recommendations into patient treatment plans and reasons for non-adherence.
Results: Multidisciplinary representation was assessed at 4 MTBs. The Mongolian team had 100% attendance from breast surgeons, 75% from radiologists, 50% from medical oncologists and pathologists, and 25% from radiation oncologists. The US team had 100% attendance from breast surgeons, medical oncologists, and pathologists, and 75% from radiologists. The MTB reviewed clinical staging for 50% (n=5) of patients, 60% concurred with staging and 40% required revision. Recommendation follow-up data was available for 90% (n=9) of patients. 2 (22%) adhered fully, 1 (11%) died before treatment initiation, 1 (11%) pursued treatment elsewhere, 1 (11%) required a change in treatment due to cancer progression, and 4 (44%) required treatment plan modifications due to accessibility and insurance coverage.
Conclusion: Establishing a virtual international MTB offers a collaborative way to improve breast cancer care in Mongolia, making its optimization paramount. We investigated multidisciplinary representation at the meeting, as input across specialties is critical to MTB success. There was representation amongst all parties at each MTB. While Mongolian surgeons attended each MTB, recruiting Mongolian radiologists, pathologists, radiation oncologists, and medical oncologists consistently could enhance discussions. Treatment decisions are influenced by patient stage, so we examined accuracy of presented clinical stage. Given changes to stage are not infrequent, continued education on clinical stage could help facilitate MTB recommendations. Finally, the rate of incorporation of MTB recommendations was reviewed to better understand barriers to breast cancer care in Mongolia. MTB recommendations were infrequently precisely incorporated into treatment plans, and future investigation is needed to adapt recommendations in this resource-limited setting.