CONTACTS 

SUBJECTS
Tumor Board Theory Purpose Practice Communication Collaboration Conv

4103 -
4103 -    ..
4104 - Summary/Objective
4105 -
410501 - Follow up ref SDS 33 5S84, ref SDS 31 K36G.
410502 -
410503 - Research today indicates Tumor Board systems accomplish aims of
410504 - Knowledge Mangement.  Like legal practice, Tumor Boards leverage time
410505 - and energy invested to solve complex cases by applying knowledge from
410506 - lessons learned to help other patients with similar problems, where
410507 - "management" applies technology for command and control of the record
410508 - to organize and find solutions quickly when needed. ref SDS 0 FW9K
410509 - Case study on Millie's patient history working with Kaiser's Tumor
410510 - Board, ref SDS 0 6W3X, aligns with research indicating uneven
410511 - application of procedures yields poor results. ref SDS 0 6G6H
410512 -
410513 -
410514 -
410515 -
410517 -  ..
4106 -
4107 -
4108 - Progress
4109 -
410901 - Tumor Board Collaboration Conversation Model Knowledge Management
410902 -
410903 - Follow up ref SDS 13 VA7I.
410904 -
410905 - Kaiser has a Tumor Board system for quality control that continually
410906 - improves care of cancer patients through continual learning.  Doctors
410907 - assemble every Friday to discuss complex cases, reported on 060809.
410908 - ref SDS 24 NT9S  Tumor Board presentations leverage implicit (also
410909 - "tacit") knowledge from diverse experience, e.g., oncology, surgery,
410910 - radiation, pharmacy, etc.  Collaboration shares information and
410911 - expertise to brainstorm solutions.  Multi-discipline panels focus
410912 - limited time to avoid mistakes under the common rule "many hands make
410913 - light work."  Better accuracy from increased scrutiny of patient
410914 - history and current literature eases the burden on doctors who do not
410915 - have time for review.  Solutions for patients presented to the Tumor
410916 - Board increase knowledge for treating all patients within Kaiser's
410917 - Team Care practice, reviewed on 990625. ref SDS 2 2784  Disseminating
410918 - results to save lives, time, and money is a powerful educational
410919 - derivitive of Tumor Board system, cited in research today. ref SDS 0
410920 - G16H
410922 -         ..
410923 -        [On 061228 doctor submits summary of patient history submitted
410924 -        to UCSF for consideration of participation in clincial drug
410925 -        trial as providing 5 year review of complex patient history in
410926 -        place of Tumor Board review. ref SDS 36 NP8G
410928 -  ..
410929 - Tumor Boards apply well established methods from legal practice for
410930 - solving complex problems, reviewed on 950204. ref SDS 1 WT5J  Pooling
410931 - knowledge and ideas through conversation provides a cross-check for
410932 - accuracy understanding cause and effect in the binary structure of
410933 - personal and organizational memory, explained in POIMS, ref OF 5 1101,
410934 - and sometimes associated with knowledge management, reviewed on
410935 - 011102. ref SDS 3 6E6F  Cross-fertilization is another dimension of
410936 - binary structure for learning through disciplined and directed
410937 - communication afforded by the Tumor Board process, also, cited on
410938 - 011102 as grounded in knowledge management. ref SDS 4 01FT  Literature
410939 - describes the role of structure, procedure, and leadership for
410940 - effective Tumor Board processes. ref SDS 0 2P8V  Legal practice
410941 - manages knowledge with chronology, context, and connections applied
410942 - through procedures, structure, and leadership to reach accurate
410943 - judgements.  Tumor Boards similarly disseminate solutions to
410944 - individual cases, which can help doctors care for other patients, in
410945 - the same way that case law provides an expanding body of knowledge
410946 - that guides everyone in daily life.
410948 -  ..
410949 - Case study today, shown below, ref SDS 0 6W3X, supports comment on
410950 - 060809 that Tumor Board operations can seem superficial with little
410951 - benefits for patient care. ref SDS 24 H66G
410953 -  ..
410954 - Productivity of the Tumor Board yielding benefits that aid patient
410955 - care and increase Team Care productivity through continual learning
410956 - require members to be prepared by reviewing patient history.
410957 - Structure, procedures, and leadership of the hearing focus experience
410958 - and expertise of medical professionals on precise patient requirements
410959 - and constraints.  Adding energy for understanding and leadership to
410960 - "connect the dots" of cause and effect yield the power of knowledge to
410961 - improve diagnosis and treatment for the patient under the locality
410962 - principle, reviewed on 040312. ref SDS 6 YH4G
410964 -  ..
410965 - Conversely, when Board members do not have time to be prepared, and/or
410966 - when insecurity on personal standing withholds information from the
410967 - Tumor Board to avoid embarrassment or reprisal for mistakes, when
410968 - there is no record of patient history that permits people to prepare
410969 - for the hearing, or further when patient history is long and complex,
410970 - and so requires case study to accurately understand connections of
410971 - cause and effect, then the Tumor Board dissipates the power of
410972 - knowedge toward entropy.  Without good management, as defined in
410973 - POIMS, ref OF 3 1X6G, collaboration to leverage human knowledge merely
410974 - wastes time and money that endangers patient lives by failing to
410975 - discover critical connections in time to be effective.  Without order
410976 - and structure for careful, comprehensive review patterns of cause and
410977 - effect are overlooked, rendering Tumor Board hearings mere guess and
410978 - gossip, hunch and hope "water cooler" discussions, as related on
410979 - 041222. ref SDS 13 VA7I
410981 -  ..
410982 - Research today indicates that the purpose and practice of Tumor Boards
410983 - varies, and creates controversey among practitioners and hospital
410984 - management.
410986 -  ..
410987 - Research on Tumor Boards Purpose and Practice Shows...
410988 -
410989 -    1.  Massachusetts Medical Society
410990 -
410991 -              http://www.massmed.org/Content/NavigationMenu/ContinuingEducation/Accreditation/CommitteeonAccreditationReview/Tumor_Board_Guidelin.htm
410992 -
410993 -        Tumor Board Guidelines
410994 -        April 28, 2006
410996 -         ..
410997 -        The purpose of educational activities such as case based,
410998 -        multidisciplinary cancer conferences or tumor boards is to
410999 -        improve the care of cancer patients within an institution.
411000 -        These programs also provide valuable medical education for the
411001 -        medical staff.  All pertinent disciplines are to be encouraged
411002 -        to attend and participate in these conferences.
411004 -         ..
411005 -        Pre-planned Activity
411007 -         ..
411008 -        The Tumor Committee (registry or board) is often responsible
411009 -        for conducting tumor conferences.  Cases of various types of
411010 -        diseases may be selected for presentation based on complexity,
411011 -        unusual manifestation of the disease, or special interest.
411012 -        Case presentation can include the patient's medical history,
411013 -        clinical findings, diagnostic studies, therapy modalities, and
411014 -        research data.  Decide the method of presentation in advance
411015 -        and publicize that information to the audience
411016 -
411018 -         ..
411019 -    2.  Radiation Oncology Program
411020 -
411021 -        Locations: Froedtert Memorial Lutheran Hospital (FMLH), VA
411022 -        Medical Center (VAMC), Childrens Hospital of Wisconsin (CHW),
411023 -        Community Memorial Hospital (CMH), Menomonee Falls
411025 -         ..
411026 -        Chairman: J. Frank Wilson, MD, FACR
411027 -        Program Director: Colleen A. Lawton, MD, FACR
411028 -        Medical Education Assistant: Cheri McElhatton
411029 -        E-mail: cherim@mcw.edu
411030 -        Telephone: (414) 805-4472
411032 -         ..
411033 -        Tumor Board:
411035 -         ..
411036 -        Residents participate in multiple multi-disciplinary tumor
411037 -        boards.  The conferences are working tumor boards whose
411038 -        purpose is to discuss the management of patients currently
411039 -        receiving treatment.  Conferences are attended by attending
411040 -        staff from Radiation Oncology, Medical Oncology, Surgery,
411041 -        Radiology, and Pathology.  Tumor Boards include:
411042 -
411043 -            ENT Tumor Board (VA):  1st and 3rd Wednesday of month.
411044 -            Multi-disciplinary Tumor Board: Weekly, Friday morning
411045 -            Pediatric Tumor Board:  Weekly, Thursday Morning
411046 -            Gynecologic Tumor Board: Weekly, Thursday Morning
411047 -            Breast Tumor Board: Weekly, Monday, Noon.
411048 -            Thoracic Tumor Board (VA):  Alternating Thursdays
411050 -         ..
411051 -        Didactic Lectures:
411053 -         ..
411054 -        Clinical didactic lectures are given by attending staff at
411055 -        Grand Rounds.  These hour-long lectures take place Wednesday
411056 -        evenings at 5:00 pm, September through June.  Topics include
411057 -        reviews of the current status of treatment of various
411058 -        malignancies as well as discussions of novel research concepts
411059 -        and data.
411061 -         ..
411062 -        Didactic lectures in Physics are given twice per week Sept -
411063 -        June.  Lectures will be held at noon on Tuesdays and Fridays.
411064 -        Lectures cover topics required for board exams including
411065 -        production of X-Rays, measurement, dosimetry, radiation safety,
411066 -        etc.
411068 -         ..
411069 -        Lectures in Radiation Biology are held Wednesdays at noon
411070 -        November - June.  Topics covered include cell survival,
411071 -        response of normal tissues, radiation mutagenesis and
411072 -        carcinogenesis, dose and fractionation response data, molecular
411073 -        biology, hyperthermia, etc.
411074 -
411076 -         ..
411077 -    3.  Patient's right to choose enabled by doctor's duty to disclose.
411078 -
411079 -        American Association for Health Freedom
411080 -
411081 -        Amicus Briefs
411082 -
411083 -              http://www.healthfreedom.net/aahf/showarticlenew.asp?articleid=59
411085 -         ..
411086 -        IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
411087 -        FIRST APPELLATE DISTRICT, DIVISION FOUR
411088 -        RIC SCHIFF AND PAULA SCHIFF,
411089 -        Plaintiffs and Appellants
411090 -        v.
411092 -         ..
411093 -        MICHAEL J. PRADOS,
411094 -        Defendant and Respondent.
411096 -         ..
411097 -        AMICUS CURIAE BRIEF OF THE
411098 -        American Association for Health Freedom
411099 -        IN SUPPORT OF APPELLANTS
411101 -         ..
411102 -        Appeal From The San Francisco County Superior Court
411103 -        Honorable David A. Garcia, Judge
411104 -        SFSC Case No. 982109
411106 -         ..
411107 -        Jonathan W. Emord David Harris
411108 -        Emord & Associates P.C Sinnot, Dito, Moura & Puebla
411109 -        Burke Professional Center 660 South Figueroa Street
411110 -        5282 Lyngate Court Suite 2300
411111 -        Burke, Virginia 22015 Los Angeles, California 90017
411112 -        (202) 466-6937 (213) 996-4200
411114 -         ..
411115 -        Attorneys for Amicus Curiae
411116 -        American Association for Health Freedom
411118 -         ..
411119 -        II Introduction
411121 -         ..
411122 -        The trial court erred in granting summary judgment in this
411123 -        case. Disclosure of potentially efficacious experimental
411124 -        treatments is the minimum legal duty oncologists must bear in
411125 -        the treatment of terminally ill patients for whom conventional
411126 -        treatments have proven ineffective. That is also the minimum
411127 -        duty society must place upon those the state licenses to treat
411128 -        the terminally ill in such circumstances.
411130 -         ..
411131 -        At a minimum, the law of informed consent must ensure that
411132 -        each patient is given the information necessary to exercise
411133 -        informed choice in the selection of treatment. In no case is
411134 -        the law of informed consent more indispensable than in the
411135 -        treatment of the terminally ill for whom conventional
411136 -        treatments have failed. The case of cancer patient Crystin
411137 -        Schiff tragically proves the consequences that befall an
411138 -        innocent child when physicians presume not only the ultimate
411139 -        knowledge of treatment but also the ultimate power to exercise
411140 -        treatment choice.
411142 -         ..
411143 -        It is, in the end, the patient''s right to decide which
411144 -        treatment to accept and the physician''s duty to inform the
411145 -        patient of potentially efficacious treatments.  The medical
411146 -        community is not a dictatorship that reserves unto itself all
411147 -        power over what to introduce into the human body in the fight
411148 -        for wellness.  The body remains the private property of the
411149 -        patient and the doctor remains the patient's servant.
411151 -         ..
411152 -        The physician's duty is to the patient, not the other way
411153 -        around.  It is a relationship of trust and guidance, not
411154 -        unilateral control.  Informed consent means little if it does
411155 -        not empower patient choice.  The Schiffs were denied the right
411156 -        to choose by physicians who presumed it their exclusive
411157 -        province to make treatment choices.  Amicus AAHF hopes this
411158 -        court will recognize the error of that thinking and correct it
411159 -        by reversing and remanding this case for a jury trial.
411161 -         ..
411162 -        The facts of this case make the legal choice a stark one with
411163 -        profound consequences for society. Aware that chemotherapy and
411164 -        radiation therapy had never cured a childhood rhabdoid brain
411165 -        cancer and aware that antineoplastons were a potentially
411166 -        efficacious alternative treatment for that cancer (JA 657:4-9,
411167 -        677), Dr. Prados and the UCSF tumor board nevertheless
411168 -        withheld information about antineoplastons from the Schiffs
411169 -        and led them to believe that their only choice was to pursue
411170 -        treatment regimes that had never succeeded in curing a single
411171 -        childhood rhabdoid brain cancer. The physicians'' failure to
411172 -        disclose deprived Mr. and Mrs. Schiff of the information they
411173 -        needed to exercise a meaningful choice in the treatment of
411174 -        their terminally ill daughter. That failure denied the Schiffs
411175 -        knowledge of the potential risks and potential benefits of
411176 -        antineoplastons and deprived them of an opportunity to compare
411177 -        that experimental treatment with the failed conventional
411178 -        treatments. That failure denied the Schiffs a full and fair
411179 -        opportunity to fight Crystin''s cancer on terms they found
411180 -        acceptable.
411182 -         ..
411183 -        III When a Patient Is Terminally Ill and Conventional
411184 -        Treatments Have Proven Ineffective, Meaningful Informed Consent
411185 -        Requires Physician Disclosure of Experimental Treatments That
411186 -        May Prove Efficacious
411188 -         ..
411189 -        In order to understand why meaningful informed consent
411190 -        necessarily includes disclosure of experimental treatments that
411191 -        may prove efficacious when conventional treatments have failed
411192 -        one must first look to the history of informed consent and its
411193 -        legal development.  When it first arose in the 1950s, informed
411194 -        consent doctrine took one of two approaches - a physician''s
411195 -        point of view or a patient''s point of view.  About half of the
411196 -        states follow the physician''s point of view which requires
411197 -        physicians to disclose to patients information which a
411198 -        "reasonable medical practitioner" would provide.  See Peter H.
411199 -        Schuck, Rethinking Informed Consent, 103 Yale L.J. 899, 916
411200 -        (1994); Barry R.  Furrow et al., Liability and Quality Issues
411201 -        in Health Care 337 (1991).  The other half of the states follow
411202 -        the patient''s point of view which requires physicians to
411203 -        disclose to patients all facts, risks and alternatives that a
411204 -        reasonable person in the patient''s situation would consider
411205 -        important in deciding whether or not to have a recommended
411206 -        treatment.  See generally Canterburry v.  Spence, 464 F.2d 772,
411207 -        787 (D.C.  Cir. 1972).  The patient''s point of view places its
411208 -        emphasis on patient autonomy over physician judgment.
411209 -
411210 -        A. Development of Informed Consent Doctrine in California
411212 -         ..
411213 -        California has adopted the patient''s point of view on informed
411214 -        consent.  See Cobbs v.  Grant, (1972) 8 Cal.3d 229.  In Cobbs,
411215 -        the California Supreme Court held a duty of "reasonable
411216 -        disclosure of the available choices with respect to proposed
411217 -        therapy, and of the dangers inherently involved in each" an
411218 -        integral part of the physician's overall obligation to the
411219 -        patient.  Id. at 243.  The Cobbs' Court further stated: "The
411220 -        patient's right of self-decision is the measure of the
411221 -        physician''s duty to reveal.  That right can be effectively
411222 -        exercised only if the patient possesses adequate information to
411223 -        enable an intelligent choice.  The scope of the physician's
411224 -        communications to the patient, then, must be measured by the
411225 -        patient's need, and that is whatever information is material to
411226 -        the decision." Id. at 245.  Therefore, a physician has a legal
411227 -        duty to disclose to the patient all material information.  In
411228 -        the Schiff case, Dr.  Prados and the UCSF tumor board violated
411229 -        the patient's right of self decision by depriving the patient
411230 -        and her parents of basic information about a potentially
411231 -        efficacious experimental alternative to the failed approach of
411232 -        chemotherapy and radiation.
411234 -         ..
411235 -        B. Context of the Circumstances, Not a Bright Line Exclusionary
411236 -        Rule, Should Determine What Information Must Be Disclosed in
411237 -        Order for There to Be Meaningful Informed Consent
411239 -         ..
411240 -        Three years after Cobb, the California Supreme Court stated
411241 -        that "material information is that which the physician knows or
411242 -        should know would be regarded as significant by a reasonable
411243 -        person in the patient''s position when deciding to accept or
411244 -        reject the recommended medical procedure." Truman v.  Thomas,
411245 -        (1980) 27 Cal.3d 285, 291; see also Sard v.  Hardy, (1977) 281
411246 -        Md. 432, 444; [379 A.2d 1014]; Wilkinson v.  Vesey, (1972) 110
411247 -        R.I. 606, 627 [295 A.2d 676].  To be material, a fact must also
411248 -        be one which is not commonly appreciated.  See Truman, 27
411249 -        Cal.3d at 291; see also Spence, 464 F.2d at 788.  Furthermore,
411250 -        if a physician knows or should know of a patient's unique
411251 -        concern or lack of familiarity with medical procedures, those
411252 -        factors expand the scope of required disclosure.  See Truman,
411253 -        27 Cal.3d at 291.  Moreover, when a given procedure inherently
411254 -        involves a known risk of death or serious bodily harm, at a
411255 -        minimum a doctor has a duty to disclose the potential risks of
411256 -        harm and to explain in lay terms the complications that might
411257 -        occur.  See Cobbs, 8 Cal.3d at 244.  The physician is also
411258 -        required to disclose any additional information a skilled
411259 -        practitioner in good standing would provide under similar
411260 -        circumstances.  See id. at 244-245.  This Court has repeatedly
411261 -        stated that juries are the proper arbiter of whether the
411262 -        information disclosed to a patient is adequate or commonly
411263 -        known and whether there are unique circumstances that require
411264 -        further physician-patient disclosure.  See Arato v.  Avedon,
411265 -        (1993) 5 Cal.4th 1172, 1186-1187; Truman, 27 Cal.3d at 293-294;
411266 -        Cobbs, 8 Cal.3d at 244-245.  The Court has rejected the notion
411267 -        of using bright line rules to determine materiality.  See
411268 -        Arato, 5 Cal.4th at 1186.
411270 -         ..
411271 -        VI. Holding the Tumor Board Liable Is Consistent With Public
411272 -        Policy
411274 -         ..
411275 -        California courts have specified eight factors in determining
411276 -        whether public policy supports recognizing a duty to disclose:
411277 -        (1) "the foreseeability of harm to the plaintiff; (2) the
411278 -        degree of certainty that plaintiff suffered injury; (3) the
411279 -        closeness of the connection between the defendant''s conduct
411280 -        and the injury suffered; (4) the moral blame attached to the
411281 -        defendant''s conduct; (5) the policy of preventing future harm;
411282 -        (6) the extent of the burden to the defendant; (7) the
411283 -        consequences to the community for imposing a duty; and (8) the
411284 -        availability, cost and prevalence of insurance for the risk
411285 -        involved." Christensen v.  Superior Court, (1991) 54 Cal.3d
411286 -        868, 885-886; Rowland v. Chrsitian, (1968) 69 Cal.2d 108, 113.
411288 -         ..
411289 -        In this case, UCSF doctors collectively treated Crystin and
411290 -        named Dr.  Byron Smith her primary doctor.  JA 782:3-4.  Dr.
411291 -        Smith was inexperienced in treating rhabdoid brain tumors.  He
411292 -        therefore sought and relied upon the advice of UCSF''s tumor
411293 -        board for "identifying treatment alternatives." JA 789:2-11.
411294 -        The tumor board, in fact, recommended that Crystin be treated
411295 -        with chemotherapy and high dose radiation, the conventional
411296 -        treatments.  Those treatments, however, have not been
411297 -        demonstrated effective against even a single childhood rhabdoid
411298 -        tumor.  See Exhibits A & B; JA 657:4-9.  Indeed, the
411299 -        conventional wisdom is that neither chemotherapy nor high dose
411300 -        radiation will alter the likelihood of patient death in such
411301 -        circumstances.
411303 -         ..
411304 -        The conventional treatments for a rhabdoid brain tumor are
411305 -        chemotherapy and high dose radiation.  If this were the only
411306 -        known treatment then Dr Byron, or for that matter any
411307 -        physician, would not need the services of a tumor board.
411308 -        Clearly, the tumor board''s purpose was to look at particular
411309 -        cases and make recommendations for other possible therapies.
411310 -        It has already been stated that Dr Byron was inexperienced in
411311 -        treating rhabdoid brain tumors and that he relied upon the
411312 -        tumor board for "identifying alternative treatments." JA
411313 -        789:2-11.  Thus, in responding to Dr Byron''s request, the
411314 -        tumor board had an obligation to disclose to Dr Byron
411315 -        potentially efficacious experimental alternative treatments and
411316 -        to advise him of their potential risks and benefits.  A finding
411317 -        of no duty would obfuscate the need for and purpose of the
411318 -        tumor board in such circumstances.  Therefore, this court
411319 -        should find that the board had a legal duty to provide
411320 -        information on alternative treatments for Crystin''s rhabdoid
411321 -        brain cancer - a duty which it breached.
411322 -
411324 -         ..
411325 -    4.  Ospital ng Maynila Medical Center
411326 -        Department of Surgery
411327 -        Manila, Philippines
411328 -
411329 -              http://omtumorboard.tripod.com/ommc_hosptumorboard03.htm
411331 -         ..
411332 -        Structuring a Hospital Tumor Board - OMMC Experience
411334 -         ..
411335 -        Janix M. De Guzman, M.D.
411336 -        Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg
411337 -        ommcsurgery@ yahoo.com
411339 -         ..
411340 -        In the United States, tumor boards have been an integral part
411341 -        of oncology management since the early 1940's.  Scholnik, et
411342 -        al., defines tumor boards as "multidisciplinary conferences
411343 -        convened for the discussion of cancer patients." (1) A Hospital
411344 -        Tumor Board (HTB) includes access to multidisciplinary
411345 -        consultation; wherein a group of physicians meet on a regular
411346 -        basis, to improve the quality of cancer care, provide
411347 -        educational opportunities for participants, and become an asset
411348 -        to the hospital and to the community. (2) Tumor boards now
411349 -        provide a forum for the discussion of treatment strategies,
411350 -        through continual updates of standard approaches from the point
411351 -        of view of all modalities.  Medical experts regard tumor boards
411352 -        as an essential component of quality control in both community
411353 -        hospitals and medical centers.
411355 -  ..
411356 - Additionally....
411357 -
411358 -        The goal of [Tumor Board] is to promote quality service to
411359 -        patients with cancers with the following objectives: to
411360 -        formulate integrated, coordinated, and comprehensive
411361 -        hospital-wide policies on the management of patients with
411362 -        cancer in the hospital; to monitor and continually improve the
411363 -        quality of care to patients with cancers; to conduct
411364 -        educational and training programs for concerned staff so as to
411365 -        facilitate implementation of hospital policies on management of
411366 -        cancer patients; and to promote research on oncology that will
411367 -        continually improve the quality of care for cancer patients.
411369 -  ..
411370 - Policy support sounds in the realm of reviewing case studies.
411372 -  ..
411373 - Problems that render Tumor Boards ineffective....
411374 -
411375 -        This arises primarily because most of hospital tumor boards
411376 -        are not structured.  Other common problems include the
411377 -        following: hospital administrators, appointed chairs, and
411378 -        oncologists do not have a clear idea on the goal and
411379 -        objectives of a Hospital Tumor Board; appointed chairs do not
411380 -        have sufficient leadership and managerial skills; turfing and
411381 -        insecurity among oncologists; and inadequate logistic support.
411382 -
411383 -
411384 -
411385 -
4114 -

SUBJECTS
Kaiser Tumor Board Case Study Knowledge Management Application Milli

6103 -
610401 -  ..
610402 - Kaiser Tumor Board Case Study Knowledge Management Application
610403 -
610404 - Millie's experience working with Kaiser's Tumor Board illustrates
610405 - review of Tumor Board processes, per above, ref SDS 0 FW9K, including
610406 - research, ref SDS 0 6G6H, that finds variability in effectiveness...
610407 -
610408 -    1.  Tumor Board review requested by doctor
610409 -        without notification to patient after
610410 -        a month because phase 1 treatment
610411 -        failed to lower CA 15-3 cancer marker;
610412 -        Kaiser lost hearing record; presentation
610413 -        of patient history, findings and
610414 -        recommendations never
610415 -        submitted............................. 020726, ref SDS 5 WF42
610417 -         ..
610418 -    2.  Tumor Board hearing again evaluates
610419 -        strategy after patient suffers
610420 -        relapse 15 months following primary
610421 -        treatment; suggested strategy of
610422 -        radiation to supraclavicular region
610423 -        after mastectomy
610424 -        surgery............................... 040517, ref SDS 7 4R59
610426 -         ..
610427 -    3.  Tumor Board re-hearing requested by
610428 -        patient to review major change in
610429 -        diagnosis, because biopsy discovers
610430 -        secondary inflammatory breast cancer
610431 -        (IBC) on 040419, 3 days after Tumor
610432 -        Board met on 040416; request re-hearing
610433 -        to review treatment planning
610434 -        rejected as unnecessary
610435 -        overkill.............................. 040517, ref SDS 7 K48O
610437 -         ..
610438 -    4.  Doctor proposed deferring Tumor Board
610439 -        hearing to revise findings and
610440 -        recommendations for treating new
610441 -        diagnosis of IBC until after a few
610442 -        months to assess response to treatment
610443 -        on Taxol and bevacizumab (Avastin)
610444 -        chemothrapy trial
610445 -        protocol.............................. 040614, ref SDS 8 4R59
610447 -         ..
610448 -    5.  Doctor recommended against requesting
610449 -        Tumor Board hearing to help resolve
610450 -        treatment dilemmas presented to the
610451 -        patient, including rising symptoms
610452 -        that have not been diagnosed: chronic
610453 -        cough, shortness of breath, heavy
610454 -        chest, fatigue........................ 040812, ref SDS 9 FV6O
610456 -         ..
610457 -    6.  Pulmonary embolism diagnosed causing
610458 -        cough, heavy chest, shortness of
610459 -        breath; major change patient profile
610460 -        removed from treatment for IBC
610461 -        with Taxol Avastin
610462 -        trial................................. 041104, ref SDS 10 RZ4I
610464 -         ..
610465 -    7.  Tumor Board hearing deferred to obtain
610466 -        guidance on dilemma patient requires
610467 -        immediate treatment for IBC, doctor will
610468 -        not prescribe Taxol nor Taxotere which
610469 -        have been effective without Avastin;
610470 -        doctor does not prescribe Taxotere
610471 -        and capecitabine recommended in
610472 -        2nd opinon by UCSF Cancer
610473 -        Center................................ 041104, ref SDS 10 Q59K
610475 -         ..
610476 -    8.  Patient requests Tumor Board review to
610477 -        develop new treatment plan; doctor
610478 -        rcommended against Tumor Board review
610479 -        to avoid embarrassment submitting a
610480 -        simple case for analysis of Stage IV
610481 -        breast cancer patient, with delayed
610482 -        diagnosis of secondary IBC, who has
610483 -        been removed from treatment due to
610484 -        side effects, and is currently
610485 -        not receiving any
610486 -        treatment............................. 041130, ref SDS 12 YR8F
610488 -         ..
610489 -    9.  IBC inexperience mastectomy surgery
610490 -        patient requests Kaiser assemble
610491 -        Tumor Board with IBC expertise to
610492 -        review risks and opportunities, and
610493 -        methods for defining scope and criteria
610494 -        to perform left breast mastectomy
610495 -        secondary IBC......................... 050324, ref SDS 14 QQ4N
610497 -         ..
610498 -   10.  Time out for due diligence planned
610499 -        to evaluate doctor's proposal for
610500 -        mastectomy surgery.................... 050727, ref SDS 15 O85O
610502 -         ..
610503 -   11.  Patient discusses need for due diligence
610504 -        review of proposal for masectomy
610505 -        surgery............................... 050729, ref SDS 16 XQ41
610507 -         ..
610508 -   12.  Time out for Tumor Board review not
610509 -        provided by Kaiser for patient to consider
610510 -        ramifications of risks and complications
610511 -        from mastectomy surgery, because Tumor
610512 -        Board hearing would delay
610513 -        surgery............................... 050913, ref SDS 17 6W4L
610515 -         ..
610516 -   13.  Tumor Board requested patient letter
610517 -        to Kaiser on strategy for treating
610518 -        3rd relapse IBC....................... 060512, ref SDS 18 4T3S
610520 -         ..
610521 -   14.  Tumor Board requested to assess
610522 -        treatment strategy for IBC
610523 -        3rd relapse........................... 060623, ref SDS 19 K36G
610525 -         ..
610526 -   15.  Tumor Board requested to assess
610527 -        treatment strategy for IBC
610528 -        3rd relapse........................... 060711, ref SDS 20 K36G
610530 -         ..
610531 -   16.  Tumor Board requested again in a
610532 -        letter to Kaiser...................... 060720, ref SDS 21 5S8F
610534 -         ..
610535 -   17.  Doctor feels Tumor Board can do no
610536 -        more than currently being
610537 -        considered............................ 060721, ref SDS 22 IP9L
610539 -         ..
610540 -   18.  Tumor Board review added urgency when
610541 -        IBC symptoms rise; sudden improvement
610542 -        in symptoms support deferring Tumor
610543 -        Board review until doctor returns
610544 -        from vacation......................... 060808, ref SDS 23 YJ9J
610546 -         ..
610547 -   19.  Tumor Board meets at Kaiser every
610548 -        Friday supported by pharmacists,
610549 -        oncologists, and other experts from
610550 -        all over.............................. 060809, ref SDS 24 NT9S
610552 -         ..
610553 -   20.  Patient obtained 2nd opinion support
610554 -        from UCSF, since Kaiser Tumor Board
610555 -        was too difficult to assemble
610556 -        in this case.......................... 060825, ref SDS 26 5R6K
610558 -         ..
610559 -   21.  Tumor board requested for strategy
610560 -        review major change in patient
610561 -        profile; request diverse panel with
610562 -        expertise and experience treating
610563 -        secondary IBC......................... 061208, ref SDS 31 ZN3F,
610564 -
610566 -         ..
610567 -   22.  5 year review Tumor Board assess major
610568 -        change patient profile treatment failed
610569 -        due to pockets of resistance to systemic
610570 -        chemotherapy, cancer may have mutated
610571 -        so switching to another protocol,
610572 -        patient suffers pulmonary embolism
610573 -        recurrence, complications lymphedema,
610574 -        multiple recurrence cellulitis, propose
610575 -        strategy of chemotherapy, drug trials,
610576 -        list of drugs and criteria for order
610577 -        of use, surgery,
610578 -        radiation............................. 061218, ref SDS 34 MN9L
610580 -         ..
610581 -   23.  Tumor Board requested again for help
610582 -        on diagnosis and treatment strategy,
610583 -        with diverse panel doctors with IBC
610584 -        experience............................ 061227, ref SDS 35 6L33
610586 -         ..
610587 -   24.  Doctor submits copy of letter submitted
610588 -        to UCSF summarizing patient history for
610589 -        considering Millie to participate in a
610590 -        clinical drug trial; proposes this
610591 -        provides "5 year review by breast
610592 -        expert................................ 061228, ref SDS 36 OU5K
610593 -
610594 -
610595 -
610596 -
610597 -
610598 -
610599 -
610600 -
610601 -
610602 -
6107 -