5.2 Multidisciplinary Cancer Case Conferences (CoC Standard 2.5)
Key Takeaways
Each year a program must present at least 15% of its annual analytic caseload at multidisciplinary cancer case conferences, and at least 80% of the cases presented must be prospective.
Prospective cases include newly diagnosed patients before treatment decisions are complete, previously treated patients who need decisions on adjuvant, recurrence or progression treatment, and patients who need supportive or palliative care decisions.
A general cancer case conference must include physician representatives from surgery, pathology, radiology, radiation oncology and medical oncology; programs define required specialties for site-specific conferences.
For each case, the discussion covers clinical and/or pathological stage, treatment planning with evidence-based national guidelines, and, where applicable, genetic testing, clinical research and supportive care options.
The Cancer Conference Coordinator presents an annual report with a full calendar year of data at the first-quarter cancer committee meeting of the following year.
Why cancer conferences matter
A multidisciplinary cancer case conference, often called a tumor board, brings the specialists who diagnose and treat cancer together to plan care for individual patients. CoC's 2020 standards explain the rationale: outcomes are better when patients are managed by a multidisciplinary team, which improves clinical decisions, outcomes and patient experience. Registrars usually run the logistics and the data. They screen and schedule cases, prepare staging summaries, record attendance and recommendations, and compile the statistics the Cancer Conference Coordinator reports. NCRA's role delineation study lists "coordinate cancer conference activities," "document cancer conference activities," and "facilitate discussion of NCCN guidelines, prognostic indicators, and options for clinical trial participation" as registrar tasks.
Standard 2.5 at a glance
| Requirement | Detail |
|---|---|
| Protocol | A written conference protocol that addresses multidisciplinary participation, the frequency and format of conferences, the required elements of discussion, the number of cases and the percentage presented prospectively, and methods for correcting areas that fall below the protocol's levels. It must be approved by the cancer committee, like every protocol. |
| Case volume | At least 15% of the annual analytic caseload presented each year |
| Prospective share | At least 80% of cases presented must be prospective |
| Repeat presentations | The same patient may be presented more than once and counted as prospective each time treatment management issues are discussed |
| Format | A general multidisciplinary conference, with or without site-specific conferences; or only site- or specialty-specific conferences, as long as there is a way to present cases that fit none of them. The program sets the frequency in its protocol. |
| Attendance | Physician attendance at a general conference must include surgery, pathology, radiology, radiation oncology and medical oncology. The program defines the required specialties for site- or specialty-specific conferences. Genetics, clinical research, palliative care, psychosocial, rehabilitation and supportive services representatives are recommended. |
| Monitoring | The Cancer Conference Coordinator monitors and evaluates conference activity and reports to the cancer committee |
| Documentation | The site reviewer attends a conference during the site visit. The protocol, the conference template, the coordinator's report and the minutes are submitted with the Pre-Review Questionnaire. The method of documenting conference activity is left to the cancer committee. |
What counts as prospective
CoC's definition is broader than "before any treatment." Prospective cases include, but are not limited to:
- Newly diagnosed patients whose treatment has not started, or has started but a decision about additional treatment is needed.
- Previously diagnosed patients who have completed initial treatment and need a decision about adjuvant treatment or treatment for recurrence or progression.
- Previously diagnosed patients who need a decision about supportive or palliative care.
A retrospective presentation is one with no open management decision. Examples include an educational review of a patient whose treatment ended years ago, or a morbidity and mortality style review after the patient's death. Retrospective presentations count in the total number of cases presented, but not toward the 80% prospective share.
Worked example: counting the numbers
A program's annual analytic caseload is 1,000 cases.
- Minimum presentations: 15% of 1,000 = 150.
- Minimum prospective presentations: 80% of the cases presented. If exactly 150 are presented, at least 120 must be prospective.
- If the program presents 180 cases and 140 are prospective, then 140/180 = 77.8%, which is below the 80% requirement even though the 15% volume requirement is met. The coordinator's report must include an action plan.
Elements of discussion
The protocol and the coordinator's report must show that each case discussion included, as applicable:
- Clinical and/or pathological stage. Registrars often prepare a draft AJCC stage for the presenting physician.
- Treatment planning using evidence-based national guidelines, such as the NCCN Guidelines.
- Options and eligibility for genetic testing, where applicable.
- Options and eligibility for clinical research studies, where applicable.
- Options and eligibility for supportive care services, where applicable.
The Cancer Conference Coordinator's annual report
The coordinator presents the report at the first-quarter cancer committee meeting, and it must contain the previous full calendar year of data. It must include:
- Conference frequency.
- Multidisciplinary physician attendance, measured against the specialties the protocol requires.
- The number of cases presented and the percentage that were prospective.
- Whether each required element of discussion took place.
- An action plan for any area that did not meet the protocol.
An ODS may serve as the Cancer Conference Coordinator (Standard 2.1), which is one of only two coordinator roles an ODS may hold.
The registrar's workflow
| Phase | Registrar tasks |
|---|---|
| Before | Receive case requests; screen for analytic status and prospective intent; draft a case summary (history, imaging, pathology, biomarkers, draft stage); ask pathology and radiology to review the material; post the agenda |
| During | Record attendance by specialty; document the stage discussed, guideline-based recommendations, genetic and trial eligibility discussion and supportive care referrals, without adding identifiers beyond what the program's documentation policy allows |
| After | Log each presentation (date, conference type, prospective or not, elements discussed); link the discussion to the abstract where the software allows; compile the annual statistics for the coordinator |
Conference records may be protected by state peer review statutes, so follow the program's privacy and documentation rules. CoC states that programs are expected to follow local, state and federal requirements on privacy, risk management and peer review.
Exam traps
- Standard number. Cancer conferences are Standard 2.5. Standard 2.2 is the Cancer Liaison Physician.
- 15% vs. 80%. 15% is the share of the annual analytic caseload that must be presented; 80% is the share of presented cases that must be prospective.
- Prospective does not mean "before any treatment." A previously treated patient presented for a decision about treating a recurrence is prospective.
A patient whose rectal cancer was resected two years ago is presented at the cancer conference because a new liver lesion was found and the team must decide on treatment. How is this presentation classified under CoC Standard 2.5?
Retrospective, because the patient's initial treatment was completed two years ago
Not countable, because only newly diagnosed cases count toward conference requirements
Prospective, because a previously diagnosed patient needs a decision about treatment for recurrence or progression
Prospective only if the patient has never been presented before
A program with an annual analytic caseload of 800 cases presented 130 cases at its conferences last year, and 110 of them were prospective. What should the Cancer Conference Coordinator's report conclude?
Both requirements are met, because 130 is more than 10% of the caseload.
Both requirements are met: 130 is at least 15% of 800 (120), and 110 of 130 (84.6%) is at least 80% prospective.
The volume requirement is met, but the prospective share fails because it must be 100%.
The volume requirement fails, because 20% of the caseload must be presented.
A program holds a general multidisciplinary cancer case conference. Under Standard 2.5, which physician specialties must be represented in attendance?
Surgery, medical oncology and pathology only
Only the specialties listed in the program's protocol, since CoC sets no minimum for general conferences
Surgery, pathology, radiology, radiation oncology, medical oncology, genetics and palliative care
Surgery, pathology, radiology, radiation oncology and medical oncology
Sections you finish are checked off in the contents.