title: Tumor boards and the quality of cancer care.
abstract: BACKGROUND
  Despite the widespread use of tumor boards, few data on their effects on cancer care exist. We assessed whether the presence of a tumor board, either general or cancer specific, was associated with recommended cancer care, outcomes, or use in the Veterans Affairs (VA) health system.
  
  
  METHODS
  We surveyed 138 VA medical centers about the presence of tumor boards and linked cancer registry and administrative data to assess receipt of stage-specific recommended care, survival, or use for patients with colorectal, lung, prostate, hematologic, and breast cancers diagnosed in the period from 2001 to 2004 and followed through 2005. We used multivariable logistic regression to assess associations of tumor boards with the measures, adjusting for patient sociodemographic and clinical characteristics. All statistical tests were two-sided.
  
  
  RESULTS
  Most facilities (75%) had at least one tumor board, and many had several cancer-specific tumor boards. Presence of a tumor board was associated with only seven of 27 measures assessed (all P < .05), and several associations were not in expected directions. Rates of some recommended care (eg, white blood cell growth factors with cyclophosphamide, adriamycin, vincristine, and prednisone in diffuse large B-cell lymphoma) were lower in centers with hematologic-specialized tumor boards (39.4%) than in centers with general tumor boards (61.3%) or no tumor boards (56.4%; P = .002). Only one of 27 measures was statistically significantly associated with tumor boards after applying a Bonferroni correction for multiple comparisons.
  
  
  CONCLUSIONS
  We observed little association of multidisciplinary tumor boards with measures of use, quality, or survival. This may reflect no effect or an effect that varies by structural and functional components and participants' expertise.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. keating@hcp.med.harvard.edu
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Lamont
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Bozeman
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: McNeil
mesh_terms: D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008498:Medical Record Linkage; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D010348:Patient Care Team; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D012042:Registries; D015996:Survival Rate; D014481:United States / Q000453:epidemiology