How to conduct a virtual tumour board for oesophageal cancer

A virtual tumour board brings surgeons, gastroenterologists, medical oncologists, radiation oncologists, radiologists, pathologists, specialist nurses and allied health professionals together to agree on a coordinated cancer plan. For oesophageal cancer, this multidisciplinary approach is especially valuable because treatment depends on tumour location, histology, stage, fitness, nutrition and the patient’s goals.

An effective online meeting is more than a video call. It requires reliable clinical information, clear decision-making roles, secure technology and a process for recording recommendations. The format can support metropolitan centres in Sydney or Melbourne, regional hospitals in Queensland and Western Australia, and clinicians caring for patients who cannot travel regularly.

The educational focus of the ISDE 2021 congress included scientific exchange, research abstracts and international discussion of oesophageal disease. Those principles translate well to a modern virtual multidisciplinary team, provided local Australian pathways, privacy obligations and access to clinical trials are built into each case review.

Define the purpose and membership

The meeting should have a written purpose, such as confirming diagnosis, staging disease, assessing operability or reviewing treatment response. A defined scope prevents the discussion from becoming a general case conference without a clear clinical outcome.

Core membership usually includes an upper gastrointestinal surgeon, gastroenterologist, medical oncologist, radiation oncologist, radiologist, pathologist, clinical nurse consultant and dietitian. A palliative care clinician, speech pathologist, pharmacist, social worker or genetic counsellor may join when relevant. Each participant should understand whether they are providing advice, making a specialty recommendation or approving a treatment pathway.

A chair keeps the discussion focused, while a coordinator manages attendance, consent, case files and follow-up actions. For a service spanning Brisbane, Perth or rural New South Wales, rotating meeting times can reduce the burden created by long travel distances and competing hospital schedules.

Prepare a complete case before the meeting

Cases should be submitted through a standard electronic form at least 24 to 48 hours before the conference. The summary should include symptoms, endoscopy findings, biopsy results, tumour site, comorbidities, performance status, nutritional status, medications, patient preferences and the specific question for the board.

Imaging should include the relevant CT, PET-CT, MRI or endoscopic ultrasound studies, with dates and comparison scans clearly labelled. The pathologist should confirm histological type, grade, biomarkers and whether additional testing is required. Missing information should be identified before the meeting rather than discovered during a hurried presentation.

Australian teams can align documentation with Cancer Australia resources, state-based pathways and evidence-based guidance such as eviQ where appropriate. The board should also record whether the patient may be eligible for a clinical trial, compassionate access programme or referral to a high-volume oesophagogastric centre.

Build a secure and dependable online room

Use an organisation-approved platform with individual logins, waiting-room controls, strong authentication and encrypted transmission. Personal email accounts, uncontrolled screen recording and public links create avoidable privacy risks. Clinical images should be displayed from approved systems rather than downloaded to unmanaged devices.

Every participant should test their microphone, camera, bandwidth and screen-sharing permissions before the first meeting. A dial-in option helps when clinicians are travelling between hospitals or working in areas with unreliable broadband. The chair should nominate a technical host who can manage admissions, mute disruptions and resolve connection problems.

Australian health services should follow their local privacy, records-management and cyber-security requirements. Do not assume that a platform is suitable because it is widely used for ordinary meetings; clinical governance teams may require a specific configuration, vendor agreement or retention policy.

Run the discussion with a consistent sequence

Begin by confirming patient identity, consent status and the clinical question. The presenter can then give a two-minute summary, followed by pathology, radiology and specialty comments. The chair should distinguish confirmed findings from assumptions and invite the relevant specialists to address staging, resectability, systemic therapy, radiotherapy, nutrition and supportive care.

The final decision should state the recommended treatment, its intended sequence, the clinician responsible for arranging it and the timeframe. If the board cannot reach a recommendation, document the disagreement and specify what additional information is needed. A patient-centred plan should include functional outcomes, travel requirements, treatment toxicity and the person’s preferences.

For Aboriginal and Torres Strait Islander patients, teams should consider culturally safe communication, family involvement and access to Aboriginal health services. An interpreter, Indigenous liaison officer or support person may be essential, particularly when complex choices about surgery, neoadjuvant therapy or palliation are discussed.

Record outcomes and communicate promptly

The coordinator should produce minutes that capture the diagnosis, stage, evidence reviewed, recommendation, dissenting views, action owner and review date. The record belongs in the authorised clinical record, with access limited to staff involved in care. A separate task register can track referrals, molecular testing, trial screening, dietetic review and repeat imaging.

The treating clinician remains responsible for discussing the recommendation with the patient and obtaining consent. A virtual board does not replace a consultation, physical examination or shared decision-making conversation. Telehealth may be useful for follow-up, but patients may still need face-to-face assessment at a tertiary centre or local hospital.

Clear communication is particularly important when care is shared between metropolitan and regional services. The discharge summary or referral letter should explain who will deliver chemotherapy, manage nutrition, coordinate radiotherapy and respond to urgent symptoms such as dysphagia, bleeding or dehydration.

Strengthen quality and participation

A virtual tumour board should be reviewed through attendance data, time from referral to decision, completion of recommendations, trial referrals and feedback from patients and clinicians. The team can audit whether cases receive appropriate pathology review, nutrition input and documented staging.

Practical measures that improve consistency include:

• Send the agenda and case pack at least one working day in advance.
• Use a standard presentation template for every oesophageal cancer case.
• Assign one chair, one presenter and one minute-taker for each meeting.
• Test image sharing and audio before the session begins.
• Include a dietitian, nurse or palliative care clinician when patient needs require it.
• Record unresolved questions with a named owner and due date.

A short annual review can identify unequal access, recurring technical failures and delays between the board’s recommendation and treatment. Results can guide training, platform changes and partnerships with regional health networks.

The strongest online conferences combine specialist expertise with disciplined administration. For oesophageal cancer, that means presenting reliable staging information, making space for patient priorities, recognising local access barriers and converting discussion into an accountable care plan. The next concrete step is to create a one-page case submission form and pilot it in the next multidisciplinary meeting.