Barriers and facilitators to multidisciplinary head & neck cancer care coordination in Tanzania.

Abstract

e13567 Background: Tumor boards (TBs) are considered a standard of care for multidisciplinary, patient-centered cancer management. In high-income countries, they have been shown to significantly influence treatment planning and clinical decision-making. However, there is scarce literature describing how to implement and sustain high-quality TBs in low- and middle-income countries (LMICs), where limited specialized infrastructure, workforce shortages, and fragmented diagnostic and referral systems may pose unique challenges. At Muhimbili National Hospital (MNH) and Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, a general adult tumor board currently functions as a referral mechanism between institutions, but stakeholders have identified the need for disease-specific TBs to improve coordination and efficiency. This study aims to characterize barriers and facilitators to implementing a disease-focused head and neck tumor board. Methods: We conducted thematic analysis of 15 semi-structured interviews with healthcare providers involved in head and neck cancer (HNC) care at MNH and ORCI, the two largest tertiary cancer centers in Tanzania. Interviews explored strengths and weaknesses of the current general TB, barriers and facilitators to effective multidisciplinary collaboration, and expectations for a disease-focused HNC tumor board. The interviews were coded and analyzed using Dedoose qualitative analysis software. Results: Providers described logistical and workflow challenges within the current general tumor board, including inconsistent meeting structure, unclear roles, and reduced engagement in the virtual format. Coordination challenges between institutions were frequently cited, particularly the absence of streamlined communication between providers and limited coordinated follow-up after tumor board discussions. Providers also highlighted barriers in cross-institution data sharing, noting that imaging and operative reports are not consistently available across sites. Despite these challenges, providers expressed a strong commitment to multidisciplinary cancer care. Facilitators included institutional prioritization of a disease-focused tumor board, buy-in across several specialties, and existing general tumor board and referral mechanisms that can be leveraged to support TB implementation. Conclusions: Barriers to a high-quality disease-focused tumor board at MNH and ORCI are largely structural. However, strong provider commitment and institutional momentum represent important facilitators that can support the implementation and sustainability of an HNC tumor board. These findings inform strategies for strengthening multidisciplinary cancer care and support the development of sustainable disease-focused tumor boards in resource-constrained settings.