Dr Flanagan on the Importance of Multidisciplinary Breast Cancer Tumor Boards

“In breast [oncology], you cannot work in a vacuum. You have to work with your multidisciplinary colleagues, beyond medical and radiation oncology. I’m a surgeon; [these discussions should also include] pathology, imaging, plastic surgery, and physical therapy [colleagues]. Everyone has to be engaged.”

Meghan R. Flanagan, MD, MPH, a physician at the Fred Hutchinson Cancer Center and an assistant professor of surgery at the University of Washington School of Medicine, provided insights into the essential nature of multidisciplinary tumor boards within modern breast cancer management.

Flanagan asserted that clinical decisions in this field should never be made in a vacuum, as the inherent complexities of the disease require a holistic view that integrates both specialized medical expertise and individual patient values. A tumor board discussion presented at the 43rd Annual Miami Breast Cancer Conference highlighted the ongoing challenge of aligning patient preferences with established standards of care. According to Flanagan, the primary objective of the multidisciplinary team is to successfully mesh these two often-competing factors to ensure that the patients remain satisfied with their chosen treatment paths but still experience maximal clinical outcomes. This process necessitates a careful evaluation of the specific disease presentation alongside the patient’s personal treatment and lifestyle goals, ensuring that the final treatment trajectory is both medically sound and personally acceptable to the patient.

Flanagan’s commentary during the tumor board discussion centered on the topic of treatment de-escalation. Flanagan cautioned that although reducing the intensity of therapy is a desirable trend in oncology, it is not feasible or safe to de-escalate every aspect of a patient's care simultaneously. Instead, the collaborative team must strategically determine which areas of treatment are most appropriate for de-escalation based on the nuances of the individual case, she emphasized.

Furthermore, Flanagan argued that a truly synergistic approach must extend far beyond the traditional boundaries of medical and radiation oncology. Speaking from the perspective of a surgeon, she emphasized the vital inclusion of specialists in pathology, imaging, plastic surgery, and physical therapy. Flanagan concluded that every member of this expanded multidisciplinary team must remain actively engaged with the patient throughout the treatment journey.