s a paediatric haematologist and oncologist, I had the privilege to work at Aga Khan University Hospital, Karachi, and Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, where many tumour boards were working. It was mandatory to discuss every newly diagnosed cancer patient before starting the treatment, during the treatment to evaluate the response and then at the end of treatment to plan the follow-up.

However, when I came to practice paediatric haem-oncology in Multan, I observed that there was no such thing as a tumour board.

Tumour boards are multidisciplinary meetings where healthcare professionals such as oncologists, surgeons – including paediatric surgeons, orthopaedic surgeons and neurosurgeons - as well as other specialists - ophthalmologists, radiologists and pathologists - come together to discuss and collaborate on complex cancer cases.

These boards review medical records, diagnostic test results and treatment options to develop a comprehensive personalised treatment plan for the patient. These discussions help ensure that patients receive the best possible care by benefitting from the expertise of the specialists.

I decided to take the initiative to develop paediatric tumour boards in Multan. My first step was to identify the health professionals in the region who specialised in paediatric and radiation oncology, surgery, radiology, pathology and other relevant specialities.

I looked for individuals who were committed to improving childhood cancer care and willing to participate in paediatric tumour board meetings.

My next step was to meet these health professionals and create a multidisciplinary team. We ensured representation from various fields to provide a well-rounded approach to cancer treatment.

Once we had made the multidisciplinary team (MDT), we scheduled regular tumour board meetings where members could discuss and review complex cancer cases. We had to decide on the frequency of meetings based on the volume of cases and available resources.

Then, there was assigning: a process of case presentations. All primary cancer healthcare teams could present childhood cancer cases to relevant medical records, test results and treatment options for discussion.

We designated a facilitator who moderated the discussions during tumour board meetings. The facilitator ensured that all relevant information was presented and encouraged collaboration among team members.

We established a secure platform for sharing patient information, including medical records, diagnostic images and treatment plans, while ensuring patient privacy and data security.

One of our objectives was to provide ongoing education and training for tumour board members to keep them updated on the latest advancements in cancer care and treatment options.

We developed clear guidelines and standard operating procedures for tumour board meetings, including case selection criteria, presentation formats and decision-making processes.

We engaged all stakeholders such as hospital administrators and health departments to garner support, allocate resources and promote the establishment of tumour boards in Multan.

Together, we made sure that the tumour boards’ focus remained on providing the best possible care for patients by encouraging open communication, collaborative decision-making and a patient-centred approach.

Together, we made sure that the tumor board’s focus remains on providing the best possible care for patients by encouraging open communication, collaborative decision-making and a patient-centered approach.

We regularly assessed the effectiveness of the tumour board meetings. We gathered feedback from participants, monitored patient outcomes and made necessary improvements to enhance the quality of care provided. We also educated patients, families and the community about the benefits of tumour boards and how they contribute to improved cancer treatment outcomes.

The road to developing tumour boards in Multan was as bumpy as expected. Many healthcare professionals were not aware of the concept and the benefits of tumor boards.

Since the tumour boards were not mandatory in the institutes and there were no incentives, some employees probably felt that they were carrying an extra burden on their shoulders. For us coordinating the schedules of busy healthcare professionals from various specialties for regular tumor board meetings was challenging and led to difficulties in maintaining consistency.

Traditional medical practices and hierarchies resisted the shift towards a collaborative and multidisciplinary approach. Overcoming hierarchical structures and ensuring equal participation of all team members in discussions and decision-making became difficult.

Another challenge came in the form of logistics. Transporting diagnostic images, pathology reports and other relevant materials to tumour board meetings was logistically complex in remote and underserved areas.

Ensuring the long-term sustainability of tumour boards requires ongoing commitment from healthcare professionals, hospital administrators and other stakeholders. The concept of multidisciplinary collaboration may not align with the prevailing medical culture in the region leading to challenges in gaining acceptance.

Overcoming the hurdles to establishing tumour boards in south Punjab requires a comprehensive and strategic approach.

We plan to educate healthcare professionals, patients and the community about the benefits of tumour boards through workshops, seminars and informational materials.

We have to identify influential champions and leaders within the healthcare community who can advocate for the establishment of tumour boards and drive change. We need to seek funding and resources from Health Departments, NGOs and private donors to address infrastructure, technology and logistical needs.

We should invest in secure and user-friendly technology platforms for data sharing, remote participation and virtual tumour board meetings to overcome scheduling and logistical challenges.

The aim is to foster a culture of inclusiveness and respect, emphasising the importance of diverse perspectives in improving patient care outcomes. We should implement change management strategies to address resistance to change, including open communication, involving stakeholders and highlighting the positive impacts of tumour boards.

All tumour board members should educate patients and their families about tumour boards and involve them in discussions about their treatment plans, fostering a patient-centred approach.

We will develop long-term plans and strategies to ensure the sustainability of tumour boards, including succession planning and institutional support. We will work closely with legal and regulatory authorities to ensure that patient data sharing and discussions within tumour boards comply with privacy and security regulations.

To move ahead, we ask for the provision of incentives and recognition to healthcare professionals who actively participate in tumour boards.

The writer is a pediatric oncologist. He is currently head and project director of paediatric oncology at Best Care Hospital, Multan