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Deep Dive into a SINGLE and SIMPLE Transformative Change for Tumor Board Discussion of Older Adults
Jun 20, 2025
In this Deep Dive Podcast, we discuss an article that was recently published in the Journal of Geriatric Oncology by Dr. Henderson and colleagues https://www.sciencedirect.com/science/article/pii/S1879406825000414 The investigators showed that a single and simple change of doing geriatric assessment and presenting data in the tumor board can transform the tumor board discussion from just a discussion about the tumor to taking the whole patient into account.
View Video Transcript
0:04
okay let's unpack this imagine you're in
0:08
uh one of those really crucial meetings
0:10
happening right now in a hospital mhm
0:12
it's the kind of room where you know a
0:15
team of experts is making potentially
0:18
life-changing decisions about how to
0:21
treat someone diagnosed with cancer
0:22
right and specifically we're talking
0:24
about an older adult patient here yeah
0:27
these meetings they're often called
0:28
tumor boards or maybe more formally
0:31
multid-disciplinary team meetings you've
0:33
got surgeons medical oncologists
0:35
radiation oncologists sometimes
0:37
paliative care folks right everyone
0:39
bringing their piece exactly everyone
0:40
bringing their expertise and they're
0:42
typically reviewing scans pathology
0:44
reports uh really the very technical
0:46
details of the disease itself and
0:48
traditionally that intense focus it's
0:50
really on the tumor isn't it its type
0:52
its stage the treatments to well target
0:55
it precisely but for an older patient
0:57
there's this whole other layer i mean
0:59
how is a potentially tough treatment
1:01
going to affect their actual life yeah
1:03
their independence their ability to just
1:05
get around their energy levels their
1:07
mood even who's there to support them
1:10
that's it and that's often where well as
1:12
a significant gap has existed you know
1:14
mhm assessing an older patient's fitness
1:17
or their ability to tolerate
1:19
treatment it's sometimes been pretty
1:21
subjective in that setting it really has
1:23
maybe it's just a quick impression what
1:25
some clinicians might even call the
1:26
eyeball test the eyeball test right or
1:29
perhaps a very general activity score
1:31
something like an ECOG score and just to
1:34
clarify for you listening that ECOG
1:36
score it's a fairly simple scale usually
1:39
0 to 5 just rating how well a patient
1:41
can do everyday things it's useful sure
1:44
but like the source points out it's
1:46
really just one piece oh absolutely it
1:49
often misses so much crucial you know
1:52
nuanced information about the person it
1:54
certainly does it doesn't systematically
1:56
capture things like their actual ability
1:58
to do daily tasks dressing cooking that
2:00
sort of thing or if they've had falls
2:02
how their nutrition is holding up their
2:04
memory or concentration their social
2:07
support system and critically what they
2:10
are most worried about regarding the
2:11
treatment itself all those factors that
2:14
really determine if a tough treatment
2:16
plan is well feasible and actually
2:18
aligned with what matters most to that
2:20
specific individual so this brings up a
2:23
really important question doesn't it
2:25
what if you could easily systematically
2:28
bring that missing piece the patient's
2:30
own perspective their context their
2:32
priorities what if you could bring that
2:34
directly into that critical
2:36
decision-making room exactly where the
2:38
actual plan is being hashed out and
2:40
here's where it gets really interesting
2:42
we're going to take a deep dive into a
2:44
study that looked at precisely this
2:46
question okay it focused specifically on
2:48
these multidisciplinary team meetings uh
2:51
discussing older adults who had
2:53
pancreatic cancer the study's title is
2:55
quite long but descriptive the impact of
2:58
electronic patient reported outcome
3:00
presentation during multiddisciplinary
3:02
tumor board on clinician discussion of
3:04
older adults fitness and preferences
3:07
okay quite a mouthful but it tells you
3:08
what it's about yeah so for this deep
3:10
dive our mission seems clear we want to
3:12
understand how these meetings typically
3:14
worked for older adults before this
3:16
research identify that vital information
3:18
about the patient that was well often
3:20
missed see the simple but it sounds like
3:23
powerful change this study introduced
3:26
and explore just how profoundly it
3:28
impacted the conversation hopefully
3:30
putting the patients voice more at the
3:31
center let's dig into the setting first
3:33
as you mentioned these tumor boards
3:35
they're the hub where all these
3:37
specialists converge right they're
3:39
looking at complex imaging microscopic
3:41
pathology
3:42
slides the focus is well intensely on
3:46
the disease itself makes sense and while
3:49
they know they need to consider if an
3:52
older patient can handle the treatment
3:53
the source material really highlights
3:55
how limited that assessment often was in
3:57
the meeting itself that's the key point
3:59
before this study's intervention an
4:01
explicit discussion about overall
4:03
fitness happened in only what just over
4:05
half the cases just over half yeah
4:06
around 55% and think about information
4:09
from a comprehensive geriatric
4:11
assessment that's a really detailed
4:13
evaluation looking at mobility nutrition
4:16
cognition mood social support all that
4:19
stuff beyond just the cancer even if
4:21
that assessment had been done beforehand
4:23
that crucial information was discussed
4:26
0% of the time in these meetings before
4:28
the intervention 0% wow that's that's
4:32
something all that valuable insight into
4:33
the person just wasn't making it into
4:35
the core discussion not systematically
4:37
no and the metrics they did sometimes
4:40
use weren't really giving the full
4:41
picture like you said the ECAR
4:42
performance score mentioned in only
4:44
about 13% of the before cases only 13%
4:48
and that subjective eyeball test we
4:50
mentioned that was relied on in about
4:52
42% of discussions so nearly half the
4:55
time it's kind of a debt feeling which
4:57
means the really core information about
4:59
the person their actual day-to-day
5:01
function fall risk nutrition memory
5:05
social situation mood and maybe most
5:08
importantly their specific worries and
5:09
preferences about treatment all of that
5:11
was largely absent from the formal tumor
5:13
board conversation exactly so the study
5:15
basically asked how do we fix this how
5:17
do you systematically capture all that
5:19
crucial missing info and actually get it
5:21
into the room into the discussion and
5:23
this is where they introduced something
5:25
called the We Care tool we care okay
5:27
what does that stand for it's short for
5:29
web enabled cancer and aging resilience
5:31
evaluation got it and it's essentially a
5:34
comprehensive questionnaire it's
5:36
designed to capture this detailed
5:38
information directly from the patient
5:40
themselves ah so it's collecting patient
5:43
recorded outcomes or pros exactly pro
5:46
information coming straight from the
5:48
horse's mouth so to speak unfiltered by
5:51
a clinician's interpretation right and
5:53
what did this weekare questionnaire
5:54
cover specifically well it dug into
5:57
precisely those areas that were often
5:59
being missed things like their ability
6:02
to do daily tasks bathing shopping
6:05
managing finances things like that okay
6:07
their mobility any history or risk of
6:09
falls their nutritional status are they
6:11
losing weight difficulty eating their
6:14
cognitive function memory issues trouble
6:16
concentrating right the practical stuff
6:18
and also their social support network
6:20
and their mood but crucially it
6:22
specifically captured their treatment
6:24
preferences and concerns this is really
6:26
key how did it do that patients were
6:28
given a list of potential worries common
6:31
things people face and asked to pick
6:33
their top three okay like what sort of
6:35
worries things like um physical side
6:38
effects the emotional toll of treatment
6:41
how it might impact their ability to
6:43
work financial burdens the impact on
6:45
their family that's a big one for many
6:47
people absolutely or even the concern of
6:50
missing important life events weddings
6:53
birthdays you name it so by gathering
6:55
this systematically using we care right
6:57
the idea was to make sure the patients
6:59
actual lived experience and their
7:01
priorities were documented and
7:03
importantly available when the team met
7:06
in the intervention itself you said it
7:08
was simple incredibly simple they took
7:10
all this comprehensive weare data for
7:12
each older adult patient and just
7:14
distilled it down they put it onto a
7:16
concise one slide summary just one slide
7:18
one slide and this single slide was then
7:21
presented during the tumor board
7:22
discussion for that specific patient
7:24
okay that sounds efficient but what
7:26
about the time cost yeah these meet
7:28
already packed right that's what's
7:29
really striking on average presenting
7:31
the summary of patient reported
7:33
information added just 36 seconds per
7:36
patient to the discussion wait 36
7:38
seconds 36 seconds that's it that's
7:40
that's barely any time at all and the
7:42
results for that minimal time investment
7:45
you you said the source called them
7:46
transformative the data makes it very
7:49
very clear why let's look at the stark
7:52
before and after comparisons they
7:54
actually audio recorded the meeting so
7:55
this is solid data okay lay it on us
7:57
before the week here summary slide
8:00
explicit talk about overall fitness you
8:02
said just over half 55% right and after
8:05
adding that one slide summary it jumped
8:07
to nearly all cases 96% wow 55 to 96%
8:11
that's that's not just an increase it's
8:13
a fundamental shift fitness became
8:15
standard discussion absolutely and
8:17
remember that information from a
8:19
comprehensive geriatric assessment
8:20
discussed 0% of the time before zero
8:23
yeah still can't quite get over that
8:25
after introducing the weare slide that
8:27
type of crucial geriatric information
8:29
was used in 94% of discussions 0 to 94%
8:33
that's incredible so just having the
8:35
patient reported info available prompted
8:37
them to use these detailed insights
8:40
exactly even if maybe a full CGA report
8:42
was buried somewhere in the chart before
8:44
this brought the key points front and
8:46
center okay and what about those crucial
8:48
patient preferences and concerns before
8:51
you said only 10% of cases only 10%
8:54
barely registering in the formal
8:55
conversation and after the 36-second
8:58
slide it completely shifted it jumped
9:00
dramatically to 76% 10 to 76% 3/4 of the
9:04
cases think about that the patients own
9:07
deepest worries about their treatment
9:09
going from almost never discussed to
9:11
being a major topic this fundamentally
9:14
changed the content of the discussion
9:15
how so what were they talking about more
9:17
well topics like physical function
9:19
impairments fatigue malnutrition things
9:22
directly impacting daily life the source
9:24
says discussion time for those
9:26
skyrocketed okay and conversations about
9:28
psychosocial factors like social support
9:30
or the patients understanding of their
9:32
health situation even their own goals
9:34
that increased significantly too and the
9:37
source gave examples right of the kinds
9:38
of patient worries that started coming
9:40
up yeah really compelling ones things
9:42
like patients being concerned about you
9:45
know being a burden on their family or
9:48
how the treatment was going to impact
9:50
their ability to just live their daily
9:52
life maintain their independence these
9:54
were now actually part of the high-level
9:56
expert discussion so it sounds like it
9:58
really moved the tumor board discussion
10:00
beyond just analyzing the tumor itself
10:02
exactly it started the conversation
10:04
about the person who is living with the
10:06
tumor right it allowed the medical team
10:09
to gain a much more holistic
10:10
understanding of the patient their
10:13
resilience their context what their life
10:15
looks like and crucially what their
10:17
goals are beyond just fighting the
10:19
disease and what's fascinating is you
10:21
mentioned the source suggested this
10:23
didn't mean less talk about the cancer
10:25
itself no quite the opposite potentially
10:27
they proposed that those cancer related
10:30
discussions likely became richer richer
10:32
how because the team now had a better
10:34
grasp of the patients overall situation
10:37
they understood what was truly important
10:39
to that person when considering
10:41
different treatment options and their
10:42
potential impacts okay so what does all
10:44
of this mean for well for you listening
10:46
or perhaps for someone you know who
10:49
might be navigating cancer care i think
10:51
it powerfully underscores that cancer
10:53
treatment for older adults is absolutely
10:56
not a one-sizefits-all scenario right
10:58
success isn't just defined by whether a
11:00
tumor shrinks on a scan it's also and
11:03
arguably more importantly for many older
11:05
adults about how that treatment impacts
11:08
their independence their quality of life
11:10
and whether the plan actually aligns
11:12
with their values right their priorities
11:14
their deepest wishes for how they want
11:15
to live whatever time they have left
11:17
precisely and this study provides
11:19
incredibly powerful clear evidence by
11:22
systematically and very efficiently
11:24
bringing the patients own voice their
11:26
reported experiences their worries their
11:28
functional status into the room where
11:30
these highstakes decisions are made you
11:32
can fundamentally change the
11:33
conversation you make it much more
11:35
likely that the treatment plan will be
11:37
tailored not just to the disease but
11:39
crucially to the individual's life and
11:41
well-being and again that 36 second
11:44
change the sheer impact is just
11:47
remarkable it really is it shows that
11:49
making care more personalized more
11:52
centered on the whole older person it
11:54
doesn't necessarily require you know
11:56
tearing down and rebuilding the entire
11:58
system sometimes not sometimes it's
12:00
about finding these precise efficient
12:03
ways to just insert that missing piece
12:05
of information the patients perspective
12:08
right at the core of the decision-making
12:10
process and while yes this study focused
12:12
on pancreatic cancer patients at one
12:14
specific institution its implications
12:17
are truly huge yeah you can see that it
12:19
really could apply to improving
12:21
decision-m for older adults with cancer
12:23
just about everywhere it reinforces with
12:26
hard data that understanding factors
12:27
like frailty functional status patient
12:30
preferences psychosocial context this
12:32
isn't just a nice to have no it's
12:35
essential it's an essential component of
12:36
providing the best possible truly
12:39
person- centered care it's just a
12:41
powerful demonstration isn't it that
12:42
sometimes the most profound improvements
12:44
come from these relatively simple
12:47
targeted adjustments that just ensure
12:49
the patient is genuinely seen heard and
12:52
understood right at the center of their
12:54
own medical journey absolutely so the
12:57
core takeaway from this deep dive seems
12:59
pretty clear implementing a systematic
13:02
way to bring patient reported outcomes
13:04
into these critical multidisciplinary
13:06
discussions can fundamentally
13:08
dramatically shift those conversations
13:10
makes them more patient centered exactly
13:12
and remarkably it can be achieved with
13:15
surprisingly minimal added time which
13:17
kind of leaves us with this final
13:18
thought to consider right how might this
13:21
systematic gathering and clear
13:23
presentation of a patients own
13:24
experience their values their concerns
13:27
how might that transform decision-making
13:28
in other complex areas of healthcare
13:31
beyond just oncology h that's a great
13:33
question and maybe given the striking
13:35
results here what does this study
13:37
suggest about where we should focus our
13:39
efforts when we're looking for those
13:41
truly impactful patient centered
13:43
improvements in our healthare systems
13:45
where's the lowhanging fruit for making
13:47
things better
13:54
[Music]
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