CoMMa: Contribution-Aware Medical Multi-Agents for Decentralized Oncology Decision Support

Abstract

Recent multi-agent frameworks have shown promise for oncology decision support, yet most assume centralized data access and rely on prompt-based assignment, limiting their applicability in privacy-sensitive clinical settings. We propose Contribution-Aware Medical Multi-Agents (CoMMa), a decentralized LLM-agent framework where specialists operate on partitioned clinical data streams. Unlike prior approaches that share inputs across agents, CoMMa enforces data decentralization to include stronger role specialization and further enhances this via agent-specific finetuning. To enable reliable and interpretable coordination, we introduce a contribution-aware aggregation mechanism that replaces stochastic, narrative-based reasoning with deterministic embedding projections to approximate each agent's marginal utility. This yields explicit credit assignment over agents, providing a stable and interpretable decision pathway aligned with clinical requirements. We evaluate CoMMa on multiple oncology benchmarks, including real-world multidisciplinary tumor board datasets from large academic hospitals in North America and East Asia, as well as public datasets, demonstrating strong performance and generalization across heterogeneous clinical settings.