title: "A rising tide lifts all boats": establishing a multidisciplinary genomic tumor board for breast cancer patients with advanced disease.
abstract: Research suggests that multidisciplinary genomic tumor boards (MGTB) can inform cancer patient care, though little is known about factors influencing how MGTBs interpret genomic test results, make recommendations, and perceive the utility of this approach. This study's objective was to observe, describe, and assess the establishment of the Breast Multidisciplinary Genomic Tumor Board, the first MGTB focused on interpreting genomic test results for breast cancer patients with advanced disease.
  
  
  
  We conducted a qualitative case study involving participant observation at monthly MGTB meetings from October 2013 through November 2014 and interviews with 12 MGTB members. We analyzed social dynamics and interactions within the MGTB regarding interpretation of genomic findings and participants' views on effectiveness of the MGTB in using genomics to inform patient care.
  
  
  
  Twenty-two physicians, physician-scientists, basic scientists, bioethicists, and allied care professionals comprised the MGTB. The MGTB reviewed FoundationOne™ results for 40 metastatic breast cancer patients. Based on findings, the board mostly recommended referring patients to clinical trials (34) and medical genetics (15), and Food and Drug Administration-approved (FDA) breast cancer therapies (13). Though multidisciplinary, recommendations were driven by medical oncologists. Interviewees described providing more precise care recommendations and professional development as advantages and the limited actionability of genomic test results as a challenge for the MGTB.
  
  
  
  Findings suggest both feasibility and desirability of pooling professional expertise in genomically-guided breast cancer care and challenges to institutionalizing a Breast MGTB, specifically in promoting interdisciplinary contributions and managing limited actionability of genomic test results for patients with advanced disease.
authors.affiliation: Ethics Center, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Departments of Pediatrics and Women's, Gender, and Sexuality Studies, University of Cincinnati, 3333 Burnet Avenue, MLC 15006, Cincinnati, OH, 45229, USA. michelle.mcgowan@cchmc.org.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: McGowan
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, USA.
authors.forename: Roselle S
authors.initials: RS
authors.lastname: Ponsaran
authors.affiliation: Case Western Reserve University School of Medicine, University Hospitals Seidman Cancer Center, Cleveland, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Silverman
authors.affiliation: National Cancer Institute, Washington, DC, USA.
authors.forename: Lyndsay N
authors.initials: LN
authors.lastname: Harris
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Marshall
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology; D023281:Genomics; D006801:Humans; D033183:Interdisciplinary Communication; D005791:Patient Care / Q000379:methods*
keywords: Breast cancer; Ethics; Genomics; Patient care; Qualitative research