Focusing on the value of electronic systems and tumor boards, experts detail how best to communicate across disciplines in the management of breast cancer.
Charles A. Powell, MD, MBA: Having access to patient data is crucial to inform the ability to make the appropriate diagnosis and deliver the most appropriate treatment. So there’s incredibly high value to having access to clinical information, clinical imaging, clinical histories, that enhances the value of the services that can be provided by all specialists. That’s facilitated by access to electronic health records. That’s facilitated when the care is provided within a single health system that uses a uniform electronic health record. That makes it easy because all the information is accessible. Challenges occur when care may be delivered across different health systems, different providers who may use electronic health records that can be accessed across institutions, but often not. Those challenges have to be overcome because those data are essential. There are certainly ways to access data from other health systems and other electronic medical records [EMRs] so that all the information that’s necessary can be brought to bear in the clinical decision-making process. But it’s certainly facilitated when the care can be delivered in a setting where full data are available to all providers who are participating in the care of the patient.
Joyce A. O’Shaughnessy, MD: Multidisciplinary tumor boards are very useful in terms of being able to have multiple disciplines in the room reviewing a patient case and discussing management strategies. These days, there are a lot of ways we can communicate. Most of our emails are encrypted, so you can put multiple people on an email. Among our medical oncology team in the cancer center, we have specialized intranets that are secure and very easy to use. Within our EMR, we have the chart messages, of course. You can put multiple people on those chart messages. Most of our physicians are also on those. Many of our collaborators, however, aren’t part of our EMR. In the hospital too, they’re really critical. In the hospital EMR, which is different from our practice EMR, there’s the opportunity to have notes. Of course, we end up talking and texting a lot too. But within the EMR in the hospital, there can be communication among the various disciplines. But ultimately, it’s getting on the phone a lot. Some doctors I work with a lot, so we were on the phone quite a bit. Some patients have 2 cancers or have a very difficult problem, like leptomeningeal disease. There will be multiple physicians. I didn’t mention the neuro-oncologist, which is another area of expertise that’s critical for our patients with recurrent brain metastasis or leptomeningeal disease. Essentially, you’ll put together a comprehensive email and include all the disciplines who are helping that patient. Thankfully, with the technology today, it isn’t difficult when you take the time to do a comprehensive email or get on the phone.
Mark D. Pegram, MD: The best way is to be in the same conference at the same time and have a head-to-head debate. There are often great debates in tumor board conferences. There are lot of gray areas; randomized controlled trial data don’t apply to every patient. There are still lots of gray areas and lots of debates where there are data-free zones, even in 2021, if we don’t have the sophistication of randomized trial data to make an easy decision on the patient. We have to make judgment calls in many cases. This is where the debate and discussion come in. It can get heated, and everyone is passionate about their work and their knowledge base. They want to get their points across in the best way possible to get the best possible outcome. Sometimes, that brings in a lot of debate and discussion. Sometimes it comes down to the point where you may have to give a balanced discussion of a couple of pathways of treatment to the same patient at some juncture, so you can say, “According to the latest science, we’re equipoised between 2 possible treatments. We’ll present them both to you, and you can help make this decision.” Sometimes, patients weigh in on what sounds the most appealing to them. So the patient’s perspective is also critical in this decision-making process.
Transcript Edited for Clarity