Every Friday for the past nine years, a group of doctors and residents from the Comprehensive Medical Service (SMI), from different specialties and from multiple perspectives, evaluates between 12 and 15 new or complex oncological cases for three hours in the Tumor Committee.
In addition to providing peace of mind to patients, who know that a group of professionals is looking after their case, it is an ideal opportunity for training young doctors and for understanding how different types of cancer occur in the health insurance company, which provides guidelines for the implementation of prevention policies.
The head of the Oncology Department at the SMI, Professor and Doctor Gabriel Krygier, who also heads the Oncology Department at the Faculty of Medicine of the University of the Republic (Udelar), spoke about the history, functioning and importance of the Tumor Committee at SMI.
—It is a teaching and care institution that brings together specialists from different areas on a weekly basis to discuss new and complicated cases of oncological pathology. It is care-based because among the colleagues we define the best treatment option and, at the same time, it is educational because it includes the Oncology resident doctors. During the four years of training, they have the obligation to prepare the histories, put together the clinical cases and present them to the public. For them, it is a continuous learning process.
What the committee decides is included in the patient’s medical record so that any doctor at the institution can consult it. It is a joint decision by a team of specialized doctors, which gives support to the patient and the SMI. Each oncologist can then decide whether or not he or she agrees with the suggested treatment, but in general this happens because it is within an institutional framework.
—How important is the committee for SMI?
—It is a committee that has existed for nine years practically uninterruptedly, even during the pandemic. It gives support and prestige to the institution because it teaches, makes joint decisions, top-level specialists make decisions there and the residents who work with us learn.
—What specialties are represented on the committee and how do they contribute to the comprehensive treatment of the patient?
—Oncologists, surgeons, pathologists, gynecologists, mastologists, psychologists, and nutritionists are on permanent duty. Then, depending on each case, urologists, neurologists, neurosurgeons, thoracic surgeons, cardio-oncologists, gastroenterologists, plastic surgeons, hematologists, ICU physicians, infectious disease specialists, nephrologists, ENT specialists, and othalmologists may participate.
—Do all oncology cases go through the committee?
—I would say 90%. There is a small percentage that does not, since these are very low-risk cases, such as benign skin tumors or very early cervical cancer tumors. Every Friday we present between 12 and 15 patients, which means about three hours of discussion. We do not include benign pathology or what would be premalignant.
—How many patients do you receive per year?
—We have 4,100 patients in total. We have had 345 instances of the Tumor Committee to date and each case is duly documented.
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Members of the SMI Tumor Committee: Dr. Ana Alfonso, Dr. Bruno Borrelli, Dr. Diego Santana, Dr. Lucia Argentio, Prof. and Dr. Gabriel Krygier, Dr. Lucia Rivero and Dr. Pablo Lores
—What impact has the Tumor Committee had on improving the results of oncological treatments at SMI?
—First, it allows the institution to know first-hand how cancer patients present and to generate prevention policies. For example, in Uruguay the most frequent cancers in women are breast cancer, followed by colorectal and lung cancer. In men, prostate, lung and colorectal cancer (in that order). We want to know how the most prevalent pathologies present in SMI: whether in early or advanced stages, with the possibility of curative treatment or not. If the majority of patients with lung cancer are smokers, as is obviously the case, we can focus more on policies against the tobacco habit. If the majority of women with breast cancer did not have mammograms, it is a good opportunity to promote proactive behaviors so that tumors are detected in earlier stages or do not appear at all. Today SMI has quantified the number of patients it has per year with a particular pathology, how they present it and which are the pathologies with the highest incidence and mortality for the institution.
Today we are committed to preventing the most recurrent pathologies. The most frequent cancer in SMI is breast cancer, with 23% of the patients who go through the committee. This is followed by colorectal cancer (14%) and prostate cancer (10%), and lung cancer has a lower percentage compared to what occurs in the country (6.2%). Many of these cases, unfortunately, do not occur because they go directly to Palliative Care, and we are also working on that.
On the other hand, with the Tumor Committee we generate publications by resident physicians, with our support, which are presented at Uruguayan and international congresses, as posters, and in interventions with the press. For the next Uruguayan Congress of Oncology, SMI will present the nine-year experience of the Tumor Committee because it is unique in the country. There is no committee here with so many years, so well structured and, above all, so well maintained.
—How does the committee ensure that the patient’s preferences and emotional well-being are taken into account in its decisions?
—We work intensively on this issue, with a psychologist specially designated for the committee who is dedicated to psycho-oncology and works with the patients. She has already seen many of the patients, but not others, and we can quickly resolve these issues from the committee. For example, we have young children who need certain psycho-emotional support or patients in very advanced stages of the disease who need another type of care and are referred to Palliative Care.
Beyond resolving therapeutic issues, we resolve all collateral issues related to care. We know that the care systems in health insurance companies are often overwhelmed, but we always create spaces so that patients who need prompt attention can be seen as soon as possible by a colleague.
—How much does it enrich you to be part of these instances?
—A lot, because we all learn from each other. Even though oncologic pathology is the center of all this, we are enriched by all the participants. In the daily rush it is impossible to communicate with all the colleagues one would like, and this is an ideal opportunity to learn from each other. In this way, we always stay abreast of new therapies and strategies, which we then apply to our patients.
