ASCO Multidisciplinary Cancer Management Course in Brazil Offers Practical Framework for Engaging Tumor Boards

ASCO Multidisciplinary Cancer Management Course in Brazil Offers Practical Framework for Engaging Tumor Boards

Anees B. Chagpar, MD, MPH, MBA, MSc, MA, FACS, FRCS, FASCO

Mar 07, 2023

Reducing the global cancer burden is a formidable goal, but one to which ASCO is incredibly committed. Partnering with City Cancer Challenge (C/Can), ASCO is tackling this daunting task one city at a time.

Together with Julie R. Gralow, MD, FACP, FASCO, ASCO chief medical officer and executive vice president, and Ariella Gould, ASCO staff working in the International Affairs Department, I recently visited Porto Alegre, Brazil, for an ASCO Multidisciplinary Cancer Management Course (MCMC). Home to 1.5 million people, Porto Alegre is the capital of the Brazilian state of Rio Grande do Sul. The city is known for its engaged citizenry, serving as the headquarters and frequent host of the World Social Forum and pioneering the concept of participatory budgeting. It is perhaps no surprise that this city actively courted the idea of becoming one of C/Can’s 13 cities around the world dedicated to improving cancer care for its inhabitants.

C/Can is a nonprofit foundation that supports cities in low- and middle-income countries as they work to improve access to equitable, high-quality cancer care. C/Can’s strategic priorities include improving the quality of cancer infrastructure and enhancing the capacity of health professionals. The foundation’s multi-sectoral initiative helps cities to take the lead in the design, planning, and implementation of cancer treatment solutions. ASCO is pleased to partner with C/Can on a variety of programming initiatives designed to further the goals of both organizations, including the most recent MCMC in Brazil.

In Brazil, as in most countries in the world, prostate and breast cancer are the leading malignancies affecting men and women, respectively, accounting for 16.4% and 14.9% of all new cancer cases. Over the last several years, C/Can had been working hard with partners from government and civil society (including organizations like FEMAMA, a breast cancer advocacy group), along with clinicians and administrators from both public and private hospitals (like Hospital de Clinicas and HMV [Hospital Moinhos de Vento], respectively), to develop robust guidelines for prostate and breast cancer management. Over the course of three days, we heard about their work, the guidelines that had been developed, and the challenges they anticipated moving forward. We discussed interesting cases, visited public and private hospitals, and met with local health authorities and government officials. The enthusiasm to bring about improvements in cancer care was uniformly palpable.

As we reviewed the recent World Health Organization objectives in terms of diagnosing more patients at an early stage and providing timely high-quality care, the need for interdisciplinary collaboration was evident. ASCO has long been a proponent of strong multidisciplinary teamwork, with effective tumor boards that capitalize on the expertise of all disciplines.

After two packed days—the first focusing on prostate cancer and the second on breast cancer—the capstone of the third day was ASCO’s MCMC. We focused on building multidisciplinary tumor boards, getting buy-in from key stakeholders, and engaging participants. We had a mock tumor board on how not to run a tumor board, highlighting some of the personality traits that can be disruptive or disengaged as illustrated by the acting skills of our faculty, and ended with an action planning exercise for groups to consider how to move forward in their own settings.

How to Run an Effective Tumor Board

Effective Tumor Boards:

  • Are routine
  • Start on time and have an agenda
  • Participants come prepared
  • Participants show up and are engaged
  • Discussions are on point and key questions are asked
  • Enjoyable group dynamic

Ineffective Tumor Boards:

  • “Are we having tumor board today?”
  • Start late and run on forever
  • “We don’t have that information.”
  • No one shows up and/or everyone is distracted
  • “Why are we discussing this again?”
  • Contentious, with no consensus

While certainly fun (and entertaining at times), the course left participants with a real sense of purpose and drive—and a tangible plan for how to enact real change in their environments.

I always love these trips. Partly for the excited enthusiasm of the participants eager to embrace multidisciplinary care in their settings. Partly for the aspiration that these courses may have a sustainable impact on improving cancer care in their settings. But mostly for the wonderful colleagues you meet from around the world and their dedication to the cause of reducing cancer burden. I always leave these visits in awe of the amazing people I have met and the work they are doing. I can’t wait to see how they will continue to change the world for the better… one city at a time.


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