History of site-tumor conferences at Baylor Sammons Cancer Center.

I would like to comment on Dr. John C. O'Brien's article on the history of tumor site conferences at Baylor University Medical Center (1). When I was asked to write a history of the Baylor Charles A. Sammons Cancer Center in conjunction with the Baylor centennial, I enlisted the help of eight colleagues (Billie E. Aronoff, MD, W. Phil Evans, MD, Joseph W. Fay, MD, Z. H. Lieberman, MD, Carolyn M. Matthews, MD, George J. Race, MD, PhD, R. Pickett Scruggs III, MD, and C. Allen Stringer, Jr., MD). That article was published in these Proceedings (2) and updated the following year for the centennial monograph. Although Dr. O'Brien lists this article as his sole reference, it is cited only with respect to the current statistics on site-tumor conference participation. The section on site-tumor committees (p. 41) in the cancer center history documents the various multidisciplinary committees and the conferences which they direct. When the Sammons Cancer Center opened on May 1, 1976, one site conference on gynecologic oncology was already in place. There was also a “tumor board.” Many physicians felt that the older concept of a tumor board where a small group of physicians heard about patients with a variety of different types of cancer was outmoded. New advances in multidisciplinary and combined-modality approaches created the need for separate committees for the major sites. Each site-tumor committee in turn was responsible for organizing and running a site-tumor conference. The formative stages of the various Sammons site-tumor conferences were more complex than Dr. O'Brien may be aware of. In an effort to obtain support for multidisciplinary conferences early on, several of us spoke at various section meetings. The reception we received was mixed. Although many staff physicians either supported the idea or were neutral, I was told at one surgical subspecialty meeting that such a conference would be a mistake and shouldn't be undertaken because “Baylor is a private hospital.” Another physician said he would never comment about another doctor's patient in public as it might appear critical of that attending physician. Despite these objections, it was felt the concept of multidisciplinary interaction was so important for the modern care of oncology patients that we should move forward, albeit cautiously. Gradually the Sammons Cancer Center began to sponsor various site-tumor conferences. On June 20, 1978, I was asked to address the quarterly meeting of the medical staff. The title of my presentation was “The Sammons Cancer Center: Activities, Prospects, and Potential.” At that time, we had a lymphoma conference and a recently instituted multidisciplinary head and neck conference in addition to the gynecological site-tumor conference. As noted by Dr. O'Brien, the breast site-tumor conference began in 1979. Dr. William Kingsley, a superb surgical pathologist, was selected as moderator, in part because it was felt that a surgical pathologist would be less controversial than one of the clinical specialists. Any appearance of favoritism was to be avoided if these site-tumor conferences were to succeed. I agree with Dr. O'Brien that the site-tumor conferences have developed into successful endeavors. All 11 regularly held conferences remain multidisciplinary and educational in scope. Continuing medical education credit is provided, and various members of the medical staff as well as fellows, residents, medical students, nurses, and other allied health personnel attend. Over 200 of these site-tumor conferences are held annually with a total attendance exceeding 4000 participants. All are sponsored, planned, and implemented by the Sammons Cancer Center site-tumor committees, which report to the cancer center medical committee. These conferences have become the “nuts and bolts” of the Sammons Cancer Center and oncology activities at Baylor. They directly contribute to high-quality patient care and learning at multiple levels. I know of no other cancer center or institution that conducts a similar scope of regular multidisciplinary oncology conferences. The success of our conferences is a result of active participation by numerous physicians. These conferences continue to thrive because of the enthusiasm and devotion to clinical excellence of many members of our medical staff.