Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
BMC Health Serv Res. 2020 Jan 31;20(1):73. doi: 10.1186/s12913-020-4930-3.
Tumor Boards (TBs) are Multidisciplinary Team (MDT) meetings in which different specialists work together closely sharing clinical decisions in cancer care. The composition is variable, depending on the type of tumor discussed. As an organizational tool, MDTs are thought to optimize patient outcomes and to improve care performance. The aim of the study was to perform an umbrella review summarizing the available evidence on the impact of TBs on healthcare outcomes and processes.
Pubmed and Web of Science databases were investigated along with a search through citations. The only study design included was systematic review. Only reviews published after 1997 concerning TBs and performed in hospital settings were considered. Two researchers synthetized the studies and assessed their quality through the AMSTAR2 tool.
Five systematic reviews published between 2008 and 2017 were retrieved. One review was focused on gastrointestinal cancers and included 16 studies; another one was centered on lung cancer and included 16 studies; the remaining three studies considered a wide range of tumors and included 27, 37 and 51 studies each. The main characteristics about format and members and the definition of TBs were collected. The decisions taken during TBs led to changes in diagnosis (probability to receive a more accurate assessment and staging), treatment (usually more appropriate) and survival (not unanimous improvement shown). Other outcomes less highlighted were quality of life, satisfaction and waiting times.
The study showed that the multidisciplinary approach is the best way to deliver the complex care needed by cancer patients; however, it is a challenge that requires organizational and cultural changes and must be led by competent health managers who can improve teamwork within their organizations. Further studies are needed to reinforce existing literature concerning health outcomes. Evidence on the impact of TBs on clinical practices is still lacking for many aspects of cancer care. Further studies should aim to evaluate the impact on survival rates, quality of life and patient satisfaction. Regular studies should be carried out and new process indicators should be defined to assess the impact and the performance of TBs more consistently.
肿瘤委员会（TBs）是多学科团队（MDT）会议，不同专业的专家在会议上密切合作，共同制定癌症治疗的临床决策。委员会的组成因讨论的肿瘤类型而异。作为一种组织工具，MDT 被认为可以优化患者的治疗效果并提高医疗服务水平。本研究的目的是进行一项综述，总结 TBs 对医疗保健结果和流程的影响的现有证据。
我们检索了 Pubmed 和 Web of Science 数据库，并查阅了参考文献。本研究仅纳入系统评价这一研究设计。我们只考虑了 1997 年以后发表的、在医院环境中进行的关于 TBs 的研究。两位研究人员通过 AMSTAR2 工具对研究进行综合，并评估其质量。
我们共检索到 5 篇发表于 2008 年至 2017 年的系统评价。其中一篇综述的重点是胃肠道癌症，共纳入了 16 项研究；另一篇综述的重点是肺癌，共纳入了 16 项研究；其余 3 项研究则涵盖了广泛的肿瘤类型，分别纳入了 27、37 和 51 项研究。我们收集了委员会的格式、成员和定义等主要特征。TBs 做出的决策导致了诊断（更准确评估和分期的可能性）、治疗（通常更合适）和生存（并非一致改善）方面的变化。其他不太突出的结果是生活质量、满意度和等待时间。
本研究表明，多学科方法是为癌症患者提供复杂治疗的最佳方式；然而，这是一个挑战，需要组织和文化变革，并且必须由有能力的卫生管理人员领导，他们可以在组织内改善团队合作。需要进一步研究来加强现有关于健康结果的文献。关于 TBs 对临床实践影响的证据在癌症治疗的许多方面仍然缺乏。进一步的研究应该旨在评估对生存率、生活质量和患者满意度的影响。应该定期进行研究，并定义新的过程指标，以更一致地评估 TBs 的影响和绩效。
