Virtual International Tumor Board – Binaytara Foundation Cancer Center Experience

Matthew Meranda; Chandrikha Chandrasekharan; Joe Rosales

doi:10.53876/001c.115896

Background

In resource-limited settings, virtual healthcare platforms can strengthen capacity with minimal infrastructure investment. The Binaytara Foundation Cancer Center (BTFCC) opened in 2018 in Janakpur, Nepal to provide regional cancer care. On inception, BTFCC lacked consistent medical oncology staffing. A virtual tumor board (VTB) was established to leverage international oncologic expertise through a flexible electronic communication platform.

Methods

Cases presented at BTFCC VTB between 1/1/23 – 6/30/2023 were reviewed. The qualifications and demographics of tumor board attendees were collected, and final recommendations offered by attending consultants were collated.

Results

Fifteen patients (median age 65 (IQR 40-72, 32)) were presented, two more than once. Most patients had advanced disease, including four (26.7%) with stage IV disease and five (33.3%) with node-positive disease. Two patients (13.3%) had hematologic malignancy. All other patients had solid tumors including head and neck (n=4), lung (n=3), gynecologic (n=3), breast (n=1) and carcinoma of unknown primary (n=1).

Each VTB was attended by a median of nine persons and was equally attended by international and Nepali participants. All VTB were attended by at least one medical oncologist with 85.7% of VTB having two or more and 23.8% of VTB having four.

Of the fifteen unique cases presented, additional diagnostics were requested in 66.6% of cases. For 33% of cases, further staging was requested prior to final recommendations. In four cases (26.6%), no change to the current treatment was recommended. In the remainder of cases, at least one additional treatment modality was recommended: additional chemotherapy in 46.6%, radiotherapy in 40%, surgical intervention in 20%, and immunotherapy in 33.3% of cases.

Conclusions

We describe the current state of BTFCC VTB as a model for building cancer care capacity in Janakpur, Nepal. Future studies will expand our dataset, evaluating VTB recommendations’ concordance with standards of care, barriers to implementation, and patient outcomes.