MUSC Health Virtual Tumor Boards

David Mahvi, M.D.

When COVID-19 ripped through health systems across the country, upending patient treatment and care, MUSC Health adapted quickly, expanding its telemedicine program and shifting its tumor board consultations to virtual platforms.

Leaders at MUSC’s National Cancer Institute-designated Hollings Cancer Center were among the first to adopt the new virtual platforms for all 11 tumor boards to help ensure that treatment and care were uninterrupted.

“Before COVID, thoracic, neuro-oncology, endocrine and breast tumor boards were meeting in-person, with some of our off-site providers joining virtually,” says Jennifer Wood, oncology nurse navigator and quality improvement coordinator for Hollings Cancer Center. “Within two weeks, all had moved to virtual meetings as a result of COVID.”

In addition to breast, neuro-oncology, endocrine and thoracic, MUSC Health has designated tumor boards for head and neck, genitourinary, gynecologic oncology, gastroenterology, malignant hematology, melanoma and sarcoma.

David Mahvi, M.D., oncology chief for MUSC’s Integrated Center of Clinical Excellence, says the virtual tumor boards will become permanent, thanks to the successful, seamless shift from in-person conferences and the popularity of the virtual platforms.

“Virtual has become the new reality, part of a national trend, and we do not plan to go back to in-person conference tumor boards,” Mahvi says. “Our physicians and clinicians have enthusiastically embraced the virtual platforms for ease of access, convenience and inclusion and its advantages for patient care.”

Wood says the virtual tumor board conferences have strong participation and multidisciplinary conversations regarding treatment planning, and the convenience factor has improved their ability to coordinate their multidisciplinary plans.

Denise Carneiro-Pla, M.D., an endocrine surgeon, agrees. “We’re absolutely able to continue providing the highest level of care. We’re still bringing different and valuable perspectives -- endocrine surgeons, endocrinologists, oncologists, pathologists, cytologists and radiologists. And we have the ability to share images and Powerpoint slides with pathology and cytology pictures to thoroughly discuss cases.”

Wood, a nurse navigator and quality improvement coordinator, has worked closely with MUSC Health tumor board operations for 10 years. A primary consideration in shifting to virtual platforms was ensuring the technology would allow compliance with national Commission on Cancer standards, including the ability for multidisciplinary discussions, review of images and pathology, discussion of stage clinical trial eligibility, supportive services and recommendations for genetic counseling.

Virtual meetings have been especially convenient for the physicians, particularly those who have clinics off-site right after tumor board. “Not only can they avoid the problem of time constraints traveling from one site to another, but in some situations, particularly breast tumor board, they’re able to discuss recommendations and plans with patients the same day their case has been discussed,” Wood says.

Tumor boards provide patients and physicians with more options than if planning were done in isolation, particularly for complex treatment decisions and clinical trials, she says. Every new breast cancer case is presented.

“It gives our breast cancer patients a lot of confidence,” she says. “They know they’re not getting input from a single provider but the entire team. It’s a comfort.”

As the state’s only academic medical center, MUSC Health has opened its tumor board conferences to physicians across the state who don’t have access to the same specialties and technologies. Thoracic and neuro-oncology have led that effort, and information is accessible on the Hollings Cancer Center website.

“The expansion of technology allows these physicians to participate and get guidance, whether they’re seeking recommendations or confirmation (about a patient’s treatment plan),” says Michael Balassone, coordinator for the virtual thoracic and virtual neuro-oncology tumor boards. “And it’s working. Some submitting physicians are only 15 minutes away; others are from the Upstate 200 miles away.”

Balassone says the process is simple and fast. Off-site physicians can submit their data and patient information to an encrypted site. Typically, a case submitted at least 24 hours before the conference date can be presented he says. “And once it has been evaluated, the board will recommend a course of treatment, usually by end of day and always within 24 hours,” Balassone says. 

“Based on recommendations, the physician can treat the patient at his or her location or refer them out for more specialized treatment if needed. And if they choose MUSC, then the physician and the patient already have some familiarity with the treatment available to them,” he says.

The ability to serve physicians and patients in rural communities that don’t have the same resources as an urban setting is incredibly valuable and gratifying says Balassone. “By helping a physician provide a high level of attention and care to a patient, we’ve also enabled that patient to get care close to home and to stay with someone they know and trust.”

That’s particularly important in South Carolina, where much of the population is considered medically under-served.

“One thing we notice is that most providers will use the service again with other patients because it provides an added layer of care,” Balassone says.

So, what does treatment look like in a post-COVID world? The medical field will change, but some things that have been implemented will remain, says David Cachia, M.D., program director for MUSC’s Virtual Neuro-Oncology Tumor Board.

The advent of telemedicine for doctors to reach out virtually and through video conferencing, particularly in medically remote areas, will hopefully remain as an option because of the advantages for patients and physicians.

“Brain tumors are rare, and these patients require more specialized care. From the physician standpoint, the Virtual Neuro-Oncology Tumor Board allows them to get expertise and opinions within 24 hours,” Cachia says.

“From the patient standpoint, it offers them the opportunity to get specialized care and recommendations and opens the door for them to get into clinical trials. It allows them to have options that would otherwise be unavailable. This infrastructure is a big development for our state that hopefully will advance patient care.”

To speak with a provider, call 843-792-2200 or 800-922-5250, or submit a case online via our Virtual Thoracic and Neuro-Oncology Tumor Boards.