Philippa Cheetham, MD; Evan C. Osmundson, MD, PhD; and Kim L. Sandler, MD, explain what a multidisciplinary tumor board is and highlight the team members who share a role in reviewing lung cancer cases and making treatment decisions.
PUBLISHED November 10, 2017
Philippa Cheetham, MD: Welcome back to Cure Connections®. Throughout today’s program, we are focusing on lung cancer, including discussions on screening, advances in treatment, and combating the social stigma associated with the disease cancer. In this segment, we are highlighting the multidisciplinary team at Vanderbilt to give you all a behind-the-scenes look at what they do every day to help patients with lung cancer. Welcome Team Vanderbilt. Thank you so much for joining me on set, Dr. Sandler, Dr. Osmundson, and Dr. Horn.
We’re going to talk in this segment about the multidisciplinary team. We’re hearing so much with other cancers about how it’s not just 1 patient, 1 doctor, or 1 scenario. We all work together in a team: not just surgeons, but radiation oncologists, medical oncologists, and all the other members of the team who come together to help patients. Let’s talk about the team that you have at Vanderbilt. Dr. Sandler, you work together treating patients with lung cancer. Tell us about the multidisciplinary setup you have there.
Kim L. Sandler, MD: I am a cardiothoracic radiologist at Vanderbilt, so I interpret images primarily of the lungs and of the heart. I read a lot of preoperative planning, perform CT scans for patients with lung cancer, help to make the diagnosis, and help to establish treatment plans. We all come together at a tumor board once a week to discuss difficult and challenging cases to try and come up with the best imaging strategies, best surgical resections, and best medical oncology care. We can all bring our different specialties together to help establish the best plan for the individual patient.
Philippa Cheetham, MD: So, when patients have imaging, guided-screening, CT scans for lung cancer detection or follow-up scans, you have an opportunity to discuss the clinical situation of that patient with the other members of the team and review it. Do you review imaging in those meetings?
Kim L. Sandler, MD: Absolutely. When we interpret a study, we have access to a patient’s medical record, and we always use that information as much as we possibly can to help formulate a decision. If we ever have any questions, everybody is just 1 phone call away, so we speak almost every day about our patients and try to make the best plan and the best interpretation of their imaging. And then, we review the imaging for individual patients together at our tumor board.
Philippa Cheetham, MD: Dr. Osmundson, we’re always taught at medical school, from radiologists in particular, that the information going in gives them better, quality information coming out. We can provide the data of patients, give them a story about why patients are being imaged and what we’re looking for. It’s not just about them seeing a scan cold without the relevant clinical information. In the multidisciplinary team, when you review imaging, you obviously review why the patients had the scan. How important is it to have experts like Dr. Sandler, who have that level of expertise in interpreting the imaging of CT scans or chest x-rays for lung cancer management?
Evan C. Osmundson, MD, PhD: It’s very, very important and essential, particularly in radiation oncology, where we rely heavily on imaging for our treatment planning. In difficult or challenging cases, I will often head down to radiology, even outside of our multidisciplinary tumor board, just to speak 1-on-1 with the radiologist and ask them, “Well, where do you think this tumor ends? Where do you think it begins? What about this, over here?” And it’s absolutely essential to provide individualized care.
Philippa Cheetham, MD: We know that many patients come to centers of excellence for a second opinion, so they’ve often already had imaging done or even met with experts to discuss treatment options. Do you find that many patients come to you for a second opinion who have already had scans done elsewhere? And, if so, do you need to get those scans reviewed or even repeated?
Evan C. Osmundson, MD, PhD: I would say that at Vanderbilt, we have a large catchment area. There are a lot of patients who do come to Vanderbilt looking for that second opinion or whose providers felt the case was complex enough to warrant multidisciplinary expertise. Oftentimes, we will upload those scans, and depending upon the quality of the scans and how recently they were done, we may ask for an interpretation or we may require some new scans. But it is always helpful to have some baseline scans for our colleagues in radiology to compare theirs to.
Philippa Cheetham, MD: Dr. Horn, we’ve heard about some of the benefits of having a multidisciplinary team meeting to review not just images, but more-so the management. Do you often find that when patients are discussed in these MDT meetings, the management plan is already decided? Or does it really change management decisions by discussing patients’ cases?
Leora Horn, MD, MSc: With the way our meetings work, you have several medical oncologists. You have a pathologist, who has got the slides that they can show us and they have reviewed, and you have thoracic surgeons. Several of those folks will come from pulmonary, as well as radiation, oncology, and radiology. For most of the cases we’re discussing, they’re cases we’re not sure what we should do with, and we wanted everybody in the room at the same time. Maybe the pathology specimen is unclear. Maybe we’re not sure: Should we treat this patient with surgery or should we go with radiation?
Sometimes, I just want to bounce ideas off some of the medical oncologists who are not necessarily in the clinic with me that day, but who are part of our clinical team, to see how they want to approach something. We might be asking the pulmonologist, “We think that’s cancer, but we’re not sure. What’s the best way for us to get a biopsy? Can you get the biopsy, or do we have to ask radiology to do the biopsy for us?” I’m a little luckier than Evan and Kim in that in our actual clinic, I share a clinic room with a thoracic surgeon and a pulmonologist. So, there’s a lot of talk between us even just during the day on, “Hey, what do you think is going on?” It’s really the more complicated patients who we’re discussing at our tumor boards.