# Mandatory national virtual tumour boards for rare and complex cancers

Source: https://onco.cc/ideas/idea-acc-national-virtual-mdt-rare-complex/  
OnCo record `idea-acc-national-virtual-mdt-rare-complex` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A patient with a rare cancer treated at a small hospital should have their case reviewed by the national experts by video before treatment starts. Make that referral automatic.

## Summary

Outcomes for sarcoma, rare gynaecological tumours, and other uncommon cancers depend heavily on expert review before surgery, yet patients at smaller hospitals are often treated locally without it. National virtual multidisciplinary boards, with mandatory pre-treatment referral for a defined list of diagnoses and a turnaround guarantee, have been implemented for sarcoma in several countries. Extending the model with a legal or reimbursement mandate would standardise access.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Mandatory national virtual review for listed rare cancers will increase the proportion treated according to expert recommendation from under 50% to above 85% and improve margin-negative resection rates.
- Rationale: Centralised expertise with decentralised delivery is the accepted model for rare disease; the internet removes the geographic excuse.
- Proposed test: Implement nationwide with a registry comparison of concordance, resection quality, and survival before and after the mandate.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- Bottleneck evidence (Fragmented care and guideline gaps): Hanna et al., Mortality due to cancer treatment delay: systematic review and meta-analysis (BMJ 2020): https://doi.org/10.1136/bmj.m4087

## Connected records

- cancers: [Neuroendocrine tumours](https://onco.cc/cancers/neuroendocrine/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/)
- key papers: [Mortality due to cancer treatment delay: systematic review and meta-analysis](https://onco.cc/key-papers/paper-hanna-bmj/)

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