Multidisciplinary Realities: Tumor Board vs Tuesday Afternoon

Tumor boards play a pivotal role in oncology care. For clinicians, they represent the ideal environment: multiple specialists, shared context, and time to debate the gray areas that guidelines can’t fully capture. However, during a busy afternoon in the clinic, the plans developed in tumor boards often prove less straightforward to implement. In this episode of Oncology Unfiltered, Melissa Cutrona, MS, and Matthew Hadfield, DO, OncData Editor in Chief, unpack why tumor boards are so valuable, where they fall short, and how to bridge the gap between a coordinated plan and the reality of care delivery on a busy clinic day. 

What Are Tumor Boards?

Dr. Hadfield describes a multidisciplinary tumor board as a recurring meeting, often weekly, where a subspecialty-focused team reviews patient cases and agrees on their management. In his cutaneous oncology tumor board, that can include specialists from dermatology, pathology, surgical oncology, radiation oncology, and medical oncology.

The motivation behind tumor boards is simple: cancer rarely follows a script. “When you look at tumor staging criteria and NCCN guidelines, it seems as though everything is very straightforward,” Dr. Hadfield says. “But there are lots and lots of gray areas in how we treat patients.” A multidisciplinary tumor board puts those gray areas on the table with the right expertise in the room. The goal is to arrive at a shared plan that reflects the full continuum of care, not just one specialty’s perspective. As he puts it, tumor board “is the best way to have a patient’s case evaluated in a very organized way.”

Which Cases Rise to the Top

Not every patient case is presented, and that’s partly by design. Dr. Hadfield notes that across specialties, boards tend to prioritize cases where multidisciplinary sequencing matters most. For many solid tumors, metastatic disease may be less likely to come forward because “there’s less of a role for radiation and surgery in those situations.” In contrast, potentially curative scenarios—especially those involving surgery—often demand careful choreography across disciplines. The board’s value is in agreeing on the sequence of treatment and surgery, surfacing what information is still missing before any one modality commits the patient to a path.

Decisions Under Pressure

The tumor board ideal is contrasted with the reality of a packed clinic schedule and incomplete information. Dr. Hadfield acknowledges that in large academic centers, real-time multidisciplinary decision-making often happens through quick “off-the-cuff conversations” and consults. He gives an example: “It’s not that uncommon for a surgical oncologist to reach out to me and say, ‘Hey, could you see this person? They have stage 2C disease. I think they might need therapy.’” The ability to quickly connect with subspecialists can bridge the time gap until the next formal conference: “If something needs to be discussed in real time and it can’t wait for a tumor board, I’m able to call the people I work with and say, ‘What do you think?’” 

But the bigger issue is access. “Where it gets much, much harder is at smaller centers where they don’t have tumor boards,” he says. Without that infrastructure, it becomes “very hard for one person to come up with a definitive plan.” The result is that multidisciplinary care can become aspirational rather than standard, especially in regions where subspecialists aren’t readily available.

Why Plans Aren’t Perfect 

Even in the best settings, tumor board recommendations don’t guarantee a smooth execution. Dr. Hadfield frames tumor board as “a snapshot in time,” and care as an evolving story. Toxicities can derail timelines. Surgical complications happen. Disease can recur. Sometimes, the plan needs to be revisited because the facts on the ground changed.

That’s why, he argues, tumor boards shouldn’t be treated as one-and-done. “Tumor boards are never a one-time thing,” he says. “It’s often an ongoing conversation,” revisited as the patient’s course unfolds and new decisions emerge.

Ownership and Handoffs

Once the tumor board reaches agreement, the next challenge is implementation: ensuring that decisions actually happen. Dr. Hadfield points to the behind-the-scenes players who make tumor boards actionable—the nurses, nurse practitioners, and nurse navigators. Actionable items are also completed promptly. If the plan is to obtain a PET scan, “that’s ordered then and there, and it’s scheduled and we get it done,” alongside the less visible work of retrieving outside pathology slides and records.

Still, breakdowns occur. “Across healthcare as a whole, there are just a lot of logistics,” he says—scheduling delays, tests that take longer than expected, and the occasional dropped thread. His practical advice to patients is direct: advocate early. “If you haven’t heard from us in five days, call us,” he tells patients, because “patients are always their own best advocate.” 

Stop Chasing “Perfect”

Asked what clinicians can do when tumor board ideals collide with clinic realities, Dr. Hadfield offers a reframing: “There is no perfect plan.” The goal is not perfection on paper—it’s the best achievable plan for the patient in front of you, at that moment, with flexibility built in for what may change. As he summarizes, “getting rid of the concept of the perfect plan and just trying to focus on the best plan for that patient, at that time, is the best we can do.”

Key Takeaways 

• Tumor boards provide a vital venue for specialists to navigate the "gray areas" of cancer care that standard guidelines cannot always address.

• A tumor board recommendation should be viewed as a snapshot in time rather than a static mandate, as patient clinical status and disease progression frequently evolve.

• The success of multidisciplinary care often hinges on the logistical follow-through of nurse navigators and clinicians to ensure that group decisions are actually executed.

• Geographic and resource-based access gaps mean that not every patient benefits from a formal tumor board, making professional networking and consults essential for community care.

• Clinicians should prioritize flexibility and the patient’s immediate needs over the pursuit of a "perfect" plan, as real-world variables like toxicity and personal preference will often shift the path forward.