18th Meeting of the EAU Section of Oncological Urology (ESOU21)

ESOU 2021: Impact of COVID-19 on Cancer Treatment: Virtual Tumor Board: Pros and Cons from Physician's Perspective

(UroToday.com) The COVID-19 pandemic has led to changes in how we manage patients, but also in how we interact with our colleagues. At the 2021 European Association of Urology (EAU) Section of Oncological Urology (ESOU) virtual meeting, Dr. Riccardo Campi discussed the pros and cons of virtual tumor boards during the pandemic.


Dr. Campi highlighted that there were several reasons as to why we had to adapt to a virtual tumor board platform, including: (i) the pandemic’s disruptive force driving innovation and accelerating change, (ii) it is unlikely that medical practice will return to pre-COVID-19 patterns in the near future and we should leverage this emergency period to improve on value for our community, and (iii) there has been a rapid transition to telemedicine and virtual experiences, and telemedicine offers benefits over standard care. However, a survey of Dr. Campi’s Twitter followers showed that only 43.3% of respondents would keep virtual tumor boards after the COVID-19 pandemic.

Looking at the literature outside of urology, there have been several reports on the current experiences with virtual tumor boards. Benefits of virtual tumor boards include improved referrals, decreased delays in diagnosis and treatment, higher frequency of tumor boards, and reduced travel burden. Additionally, a virtual “hub and spoke” model for tumor boards allows improved collaboration between providers at distant sites (ie. large academic medical centers with multiple satellite hospitals). Dr. Campi highlighted that there are several points to making an effective virtual tumor board experience, including having a patient-centered vision, team-work, data collection to assess quality metrics, as well as regular audits and implementation:1

ESOU_SWOT_analysis.png

Dr. Campi then took a SWOT analysis to virtual tumor boards:

Strengths:

  • COVID-free
  • Logistically easy as there is no need for large hospital spaces
  • Potential increased accessibility (ie. off-site providers)
  • Involvement of clinicians in geographically remote locations
  • Increased digital interactivity, including sharing screens in real-time
  • Real-time access to patients’ medical records and images shared directly by the urologist/radiologist/pathologists
Opportunities:

  • Using a hub and spoke model may overcome the concept of local tumor boards
  • Regional and national discussions, for example for rare tumors
  • Potential virtual referrals and second opinions
  • Dissemination of expertise, ie. virtual teaching for education
  • Enhanced virtual tumor boards with virtual journal clubs and social media
  • E-consult with patients and/or primary care providers
  • Increased access to patient data for audit and integration of artificial intelligence into decision-making
Weaknesses:

  • Lack of personal interaction (and informal conversation) during discussions, with potentially negative effects on human relationships and team-building
  • Potentially loss of fluidity of discussions as interactive conversations with multiple speakers can be challenging
  • Time-consuming
  • Need to be prepared as preliminary access to cases is key to maximizing time-efficiency
  • The need for and cost of a reliable virtual informatics infrastructure
Threats:

  • Maintaining professionalism, privacy, and confidentiality
  • Software difficulties and technology failures
  • The need to rebuild or reshape the team (including technical support) to cope with the increasing workload
  • Potential digital divide across board members
  • Potential heterogeneity across providers and institutions
Dr. Campi provided the following slide that excellently summarized his take-home messages regarding the pros and cons of virtual tumor boards:

ESOU_virtual_tumor_boards.png

Presented by: Riccardo Campi, MD, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia Twitter: @zklaassen_md during the 18th Meeting of the EAU Section of Oncological Urology (ESOU21), January 29-31, 2021

References:

  1. Di leva A. AI-augmented multidisciplinary teams: Hype or hope? Lancet. 2019 Nov 16;394(10211):1801.
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