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