Advancing Neuro-Oncology in Indonesia: Lessons from a Multidisciplinary Tumor Board at Cipto Mangunkusumo Hospital

Abstract

In neuro-oncology, particularly for complex cases managed within resource-constrained health systems, multidisciplinary tumor boards (MTBs) are fundamental to coordinated care. The Neuro-Oncology Meeting (NOM) at Dr. Cipto Mangunkusumo Hospital, Jakarta has operated for over 15 years, without formal performance evaluation. This study assessed NOM functions in practice and to pinpoint aspects that could be strengthened. A mixed-methods design was applied from October through December 2025 combining a retrospective review of cases from the NOM database over the preceding decade with an online questionnaire and focused group discussion (FGD) among specialists from neurology, neurosurgery, radiology, pathology, radiation oncology, and psychiatry. Responses and transcripts were then subjected to thematic analysis to delineate key performance domains. Brain tumors comprised the majority of cases (69%), followed by spinal tumors (20.3%). Common presenting symptoms included headache, motor deficits, and decreased consciousness. Over half of primary brain tumor cases lacked a definitive diagnosis at discussion. The FGD identified recurring challenges: absence of standardized case selection criteria, inadequate subspecialist representation for complex cases, lengthy presentations, inefficient handling of guideline-concordant cases, fragmented follow-up documentation, administrative constraints, and declining engagement during prolonged virtual sessions. The NOM remains essential for neuro-oncology care within a high-volume referral centre, yet workflow improvements are needed. Case stratification, concise presentation formats, consistent specialist attendance, electronic medical record (EMR)-integrated documentation, hybrid meeting models, and stricter time management could strengthen multidisciplinary practice in Indonesia and similar low- and middle- income settings.