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Zwinkels H, Dirven L, Bulbeck HJ, Grant R, Habets EJJ, Koekkoek JAF, Oberg I, Oliver K, Pace A, Rooney AG, Vos MJ, Taphoorn MJB. Identification of characteristics that determine behavioral and personality changes in adult glioma patients. Neurooncol Pract 2021; 8:550-558. [PMID: 34594569 DOI: 10.1093/nop/npab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Glioma patients may experience behavioral and personality changes (BPC), negatively impacting their lives and that of their relatives. However, there is no clear definition of BPC for adult glioma patients, and here we aimed to determine which characteristics of BPC are relevant to include in this definition. Methods Possible characteristics of BPC were identified in the literature and presented to patients and (former) caregivers in an online survey launched via the International Brain Tumour Alliance. Participants had to rate the relevance of each presented characteristic of BPC, the three characteristics with the most impact on their lives, and possible missing characteristics. A cluster analysis and discussions with experts provided input to categorize characteristics and propose a definition for BPC. Results Completed surveys were obtained from 140 respondents; 35% patients, 50% caregivers, and 15% unknown. Of 49 proposed characteristics, 35 were reported as relevant by at least 25% (range: 7%-44%) of respondents. Patients and caregivers rated different characteristics as most important. Common characteristics included in the top 10 of both patients and caregivers were lack of motivation, change in being socially active, not able to finish things, and change in the level of irritation. No characteristics were reported missing by ≥5 respondents. Three categories of BPC were identified: (1) emotions, needs, and impulses (2) personality traits, and (3) poor judgement abilities. Conclusion The work resulted in a proposed definition for BPC in glioma patients, for which endorsement from the neuro-oncological community will be sought. A next step is to identify or develop an instrument to evaluate BPC in glioma patients.
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Affiliation(s)
- Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, UK
| | - Esther J J Habets
- Department of Medical Psychology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alasdair G Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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2
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Pace A, Koekkoek JAF, van den Bent MJ, Bulbeck HJ, Fleming J, Grant R, Golla H, Henriksson R, Kerrigan S, Marosi C, Oberg I, Oberndorfer S, Oliver K, Pasman HRW, Le Rhun E, Rooney AG, Rudà R, Veronese S, Walbert T, Weller M, Wick W, Taphoorn MJB, Dirven L. Determining medical decision-making capacity in brain tumor patients: why and how? Neurooncol Pract 2020; 7:599-612. [PMID: 33312674 DOI: 10.1093/nop/npaa040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient's "best interests" and wishes are guaranteed. Several methods are available that may help to enhance patients' consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients' consent capacity, and alternative procedures, including surrogate consent.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, The Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Jane Fleming
- Department of Palliative Medicine, University Hospital Waterford, Waterford, Ireland
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland, UK
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
| | | | - Christine Marosi
- Department of Internal Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Stefan Oberndorfer
- Department Neurology, University Clinic St Pölten, KLPU and KLI-Neurology and Neuropsychology, St Pölten, Austria
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland, UK
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Simone Veronese
- Department of Palliative Care, Fondazione FARO, Turin, Italy
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, US
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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3
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Fernández-Méndez R, Wong MY, Rastall RJ, Rebollo-Díaz S, Oberg I, Price SJ, Joannides AJ. Improvement of the Efficiency and Completeness of Neuro-Oncology Patient Referrals to a Tertiary Center Through the Implementation of an Electronic Referral System: Retrospective Cohort Study. J Med Internet Res 2020; 22:e15002. [PMID: 32134389 PMCID: PMC7082731 DOI: 10.2196/15002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/03/2019] [Accepted: 12/16/2019] [Indexed: 12/03/2022] Open
Abstract
Background Quality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. Objective This study aimed to determine the impact of introducing a Web-based, electronic referral (eReferral) system to a specialized neuro-oncology center, using a service-developed proforma, in terms of waiting times and information completeness. Methods We carried out a retrospective cohort study based on the review of medical records of referred adult patients, excluding follow-ups. Primary outcome measures were durations of three key phases within the referral pathway and completion rates of six referral fields. Results A total of 248 patients were referred to the specialist center during the study period. Median (IQR) diagnostic imaging to referral intervals were 3 (1-5) days with eReferrals, and 9 (4-19), 19 (14-49), and 8 (4-23) days with paper proforma, paper letter, and internal referrals, respectively (P<.001). Median (IQR) referral to multidisciplinary team decision intervals were 3 (2-7), 2 (1-3), 8 (2-24), and 3 (2-6) days respectively (P=.01). For patients having surgery, median (IQR) diagnostic imaging to surgery intervals were 28 (21-41), 34 (27-51), 104 (69-143), and 32 (15-89) days, respectively (P<.001). Proportions of complete fields differed significantly by referral type in all study fields (all with Ps <.001) except for details of presentation, which were present in all referrals. All study fields were always present in eReferrals, as these are compulsory for referral submission. Depending on the data field, level of completeness in the remaining referral types ranged within 69% (65/94) to 87% (82/94), 15% (3/20) to 65% (13/20), and 22% (8/41) to 63% (26/41) in paper proforma, paper letter, and internal referrals, respectively. Conclusions An electronic, Web-based, service-developed specific proforma for neuro-oncology referrals performs significantly better, with shorter waiting times and greater completeness of information than other referral types. A wider application of eReferrals is an important first step to streamlining specialist care pathways and providing excellent care. International Registered Report Identifier (IRRID) RR2-10.2196/10.2196/15002
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Affiliation(s)
- Rocío Fernández-Méndez
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mei Yin Wong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca J Rastall
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Ingela Oberg
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Stephen J Price
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Alexis J Joannides
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Obex Technologies, Cambridge, United Kingdom.,Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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4
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Fernández-Méndez R, Rastall RJ, Sage WA, Oberg I, Bullen G, Charge AL, Crofton A, Santarius T, Watts C, Price SJ, Brodbelt A, Joannides AJ. Quality improvement of neuro-oncology services: integrating the routine collection of patient-reported, health-related quality-of-life measures. Neurooncol Pract 2019; 6:226-236. [PMID: 31385996 PMCID: PMC6656295 DOI: 10.1093/nop/npy040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Brain cancer has a strong impact on health-related quality of life (HRQoL), and its evaluation in clinical practice can improve the quality of care provided. The aim of this project was to integrate routine collection of HRQoL information from patients with brain tumor or metastasis in 2 specialized United Kingdom tertiary centers, and to evaluate the implementation process. METHODS Since October 2016, routine collection of electronic self-reported HRQoL information has been progressively embedded in the participating centers using standard questionnaires. During the first year, the project was implemented, and the process evaluated, through regular cycles of process evaluation followed by an action plan, monitoring of questionnaire completion rates, and assessment of patient views. RESULTS Main challenges encountered included reluctance to change usual practice and limited resources. Key measures for success included strong leadership of senior staff, involvement of stakeholders in project design and evaluation, and continuous strategic support to professionals. Final project workflow included 6 process steps, 1 decision step, and 4 outputs. Questionnaires were mostly self-completed (75.1%), and completion took 6-9 minutes. Most patients agreed that the questionnaire items were easy to understand (97.0%), important for them (93.0%), and helped them think what they wanted to discuss in their clinical consultation (75.4%). CONCLUSIONS Integrating HRQoL information as a routine part of clinical assessments has the potential to enhance individually tailored patient care in our institutions. Challenges involved in innovations of this nature can be overcome through a systematic approach involving strong leadership, wide stakeholder engagement, and strategic planning.
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Affiliation(s)
| | | | - William A Sage
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Ingela Oberg
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Gemma Bullen
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Amy Louise Charge
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Anna Crofton
- Neurosurgery Department, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Thomas Santarius
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Colin Watts
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Stephen J Price
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Andrew Brodbelt
- Neurosurgery Department, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Alexis J Joannides
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
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5
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Kiesel B, M Thomé C, Weiss T, Jakola A, Darlix A, Pellerino A, Furtner J, Kerschbaumer J, Weller M, Pilkington G, Moyal ECJ, Henriksson R, Watts C, Rudà R, Reifenberger G, Oberg I, Honnorat J, Wick W, Preusser M, Widhalm G, Berghoff A. CMET-26. PERIOPERATIVE IMAGING OF BRAIN METASTASES: A EUROPEAN ASSOCIATION OF NEURO-ONCOLOGY (EANO) YOUNGSTERS SURVEY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Carina M Thomé
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Tobias Weiss
- Department of Neurology, University Hospital Zurich, Zurich, Switzerl
| | - Asgeir Jakola
- Department of Neurosurgery, St. Olav’s University Hospital, Trondheim, Norway; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amelie Darlix
- Department of Medical Oncology, Institut régional du Cancer Montpellier, University of Montpellier, Montpellier, France
| | - Alessia Pellerino
- Dept Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | | | | | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerl
| | | | | | | | - Colin Watts
- Cambridge University Hospitals, Cambridge, England, United Kingdom
| | - Roberta Rudà
- Dept Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Ingela Oberg
- Cambridge University Hospitals, Cambridge, England, United Kingdom
| | - Jerôme Honnorat
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuro-Oncologie, Lyon, France
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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6
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Weller M, van den Bent M, Tonn JC, Stupp R, Preusser M, Cohen-Jonathan-Moyal E, Henriksson R, Le Rhun E, Balana C, Chinot O, Bendszus M, Reijneveld JC, Dhermain F, French P, Marosi C, Watts C, Oberg I, Pilkington G, Baumert BG, Taphoorn MJB, Hegi M, Westphal M, Reifenberger G, Soffietti R, Wick W. Evidence-based management of adult patients with diffuse glioma - Authors' reply. Lancet Oncol 2017; 18:e430-e431. [PMID: 28759377 DOI: 10.1016/s1470-2045(17)30515-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Michael Weller
- Department of Neurology, Brain Tumour Centre, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland.
| | | | - Jörg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Roger Stupp
- Department of Oncology, Brain Tumour Centre, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Cohen-Jonathan-Moyal
- Département de Radiotherapie, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Roger Henriksson
- Regional Cancer Centre Stockholm-Gotland and Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Emilie Le Rhun
- Neuro-Oncology, Department of Neurosurgery, University Hospital, Lille, France
| | - Carmen Balana
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Olivier Chinot
- Department of Neuro-Oncology, Aix-Marseille Université, Assistance Publique-Hopitaux de Marseille, Centre Hospitalo-Universitaire Timone, Marseilles, France
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumour Centre Amsterdam, Vrije Universiteit Medical Centre, Amsterdam, Netherlands
| | - Frederic Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Pim French
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Christine Marosi
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Ingela Oberg
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, UK
| | | | - Brigitta G Baumert
- Department of Radiation Oncology, MediClin Robert Janker Clinic and Clinical Cooperation Unit Neurooncology, University of Bonn Medical Centre, Bonn, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre and Medical Centre Haaglanden, The Hague, Netherlands
| | - Monika Hegi
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg, Hamburg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf and German Cancer Consortium, Essen/Düsseldorf, Germany
| | | | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany; German Consortium of Translational Cancer Research, Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
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7
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Pace A, Dirven L, Koekkoek JAF, Golla H, Fleming J, Rudà R, Marosi C, Rhun EL, Grant R, Oliver K, Oberg I, Bulbeck HJ, Rooney AG, Henriksson R, Pasman HRW, Oberndorfer S, Weller M, Taphoorn MJB. European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma. Lancet Oncol 2017; 18:e330-e340. [DOI: 10.1016/s1470-2045(17)30345-5] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022]
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8
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Weller M, van den Bent M, Tonn JC, Stupp R, Preusser M, Cohen-Jonathan-Moyal E, Henriksson R, Le Rhun E, Balana C, Chinot O, Bendszus M, Reijneveld JC, Dhermain F, French P, Marosi C, Watts C, Oberg I, Pilkington G, Baumert BG, Taphoorn MJB, Hegi M, Westphal M, Reifenberger G, Soffietti R, Wick W. European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol 2017; 18:e315-e329. [PMID: 28483413 DOI: 10.1016/s1470-2045(17)30194-8] [Citation(s) in RCA: 691] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/29/2016] [Accepted: 01/13/2017] [Indexed: 12/14/2022]
Abstract
The European Association for Neuro-Oncology guideline provides recommendations for the clinical care of adult patients with astrocytic and oligodendroglial gliomas, including glioblastomas. The guideline is based on the 2016 WHO classification of tumours of the central nervous system and on scientific developments since the 2014 guideline. The recommendations focus on pathological and radiological diagnostics, and the main treatment modalities of surgery, radiotherapy, and pharmacotherapy. In this guideline we have also integrated the results from contemporary clinical trials that have changed clinical practice. The guideline aims to provide guidance for diagnostic and management decisions, while limiting unnecessary treatments and costs. The recommendations are a resource for professionals involved in the management of patients with glioma, for patients and caregivers, and for health-care providers in Europe. The implementation of this guideline requires multidisciplinary structures of care, and defined processes of diagnosis and treatment.
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Affiliation(s)
- Michael Weller
- Department of Neurology, Brain Tumour Centre, University Hospital and University of Zurich, Zurich, Switzerland.
| | | | - Jörg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Roger Stupp
- Department of Oncology, Brain Tumour Centre, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Elizabeth Cohen-Jonathan-Moyal
- Département de Radiotherapie, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Roger Henriksson
- Regional Cancer Centre Stockholm-Gotland and Department of Radiation Sciences and Oncology, Umeå University Hospital, Umeå, Sweden
| | - Emilie Le Rhun
- Neuro-Oncology, Department of Neurosurgery, University Hospital, Lille, France
| | - Carmen Balana
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Olivier Chinot
- Department of Neuro-Oncology, Aix-Marseille Université, Assistance Publique-Hopitaux de Marseille, Centre Hospitalo-Universitaire Timone, Marseilles, France
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumour Centre Amsterdam, Vrije Universiteit Medical Centre, Amsterdam, Netherlands
| | - Frederick Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Pim French
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Christine Marosi
- Department of Medicine, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Ingela Oberg
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals Foundation Trust, Cambridge, UK
| | | | - Brigitta G Baumert
- Department of Radiation Oncology, MediClin Robert Janker Clinic and Clinical Cooperation Unit Neurooncology, University of Bonn Medical Centre, Bonn, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre and Medical Centre Haaglanden, The Hague, Netherlands
| | - Monika Hegi
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg, Hamburg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf and German Cancer Consortium (DKTK), Essen/Düsseldorf, Germany
| | | | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany; German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
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9
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Baird RD, Ramenatte N, Watts C, Jonson A, Jones L, Biggs H, Harrison E, Oberg I, Bullen G, Williams M, Qian W, Gilbert F, Jodrell D, Caldas C, Karabatsou K, Dunn L, Jena R, Whitfield G, Chalmers A, Jefferies S, Price S. Abstract OT1-04-01: Cambridge brain mets trial 1 (CamBMT1): A proof-of-principle phase 1b / randomised phase 2 study of afatinib penetration into brain metastases for patients undergoing neurosurgical resection, both with and without prior low-dose, targeted radiotherapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-04-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Failure of drugs to cross the blood brain barrier (BBB) can be a major reason for treatment failure for patients with brain tumors. For most patients who don't respond to treatment, it is not known whether this is due to inadequate drug concentrations in the tumor, or due to drug resistance. Preliminary data suggest that low-dose radiotherapy may disrupt the BBB, and could facilitate increased drug delivery into brain tumors. Afatinib is a potent, irreversible inhibitor of EGFR / HER2 / HER4 and takes approximately 8 days to achieve steady-state concentrations in cancer patients.
Aims
CamBMT1 has been designed to investigate the delivery of afatinib into brain metastases and whether this might be enhanced by low dose-radiotherapy.
Patient Population
Key eligibility criteria
Patients with operable brain metastases from breast or lung primaries for whom neurosurgical resection would be standard of care, as determined by the local multi-disciplinary team. ECOG PS 0, 1 or 2.
Trial design
After a phase 1b safety run- in, the phase 2 part of the trial randomises patients (n=60) into 3 pre-operative arms:
Arm 1afatinib alone for 11 days, then neurosurgery on day 12Arm 2afatinib for 11 days plus a single 2 Gy fraction on day 10, then neurosurgery on day 12Arm 3afatinib for 11 days plus a single 4 Gy fraction on day 10, then neurosurgery on day 12
Primary endpoint: to compare steady-state afatinib concentration in resected brain metastases, following afatinib administered alone, or in combination with radiotherapy (2 Gy or 4 Gy). Afatinib concentrations are measured in the resected brain metastases and in plasma.
Secondary endpoints: safety of afatinib administration in combination with radiotherapy; and multi-sequence MRI (optional) to detect changes in perfusion, vascular density, blood-brain-barrier permeability and interstitial pressure.
Exploratory endpoints: molecular profiling of resected brain metastases, for comparison with paired primary lung and breast cancers; the establishment and study of patient-derived xenografts.
Statistical methods
With 20 patients randomised in each of 3 arms in the phase 2 part of CamBMT1, the trial has a power of 84% at a significance level of 20% (one-sided) to detect an increase in afatinib concentrations with targeted radiotherapy, measured as a Cohen's D (standardised mean difference) ≥0.5.
Accrual
By the end of q2 2016, phase 1b had nearly completed enrolment. The randomised phase 2 part of CamBMT1 is due to open by q4 2016 at additional Experimental Cancer Medicine Centres.
Acknowledgments
CamBMT1 is funded by Cancer Research UK, the Brain Tumour Charity and Boehringer-Ingelheim.
Citation Format: Baird RD, Ramenatte N, Watts C, Jonson A, Jones L, Biggs H, Harrison E, Oberg I, Bullen G, Williams M, Qian W, Gilbert F, Jodrell D, Caldas C, Karabatsou K, Dunn L, Jena R, Whitfield G, Chalmers A, Jefferies S, Price S. Cambridge brain mets trial 1 (CamBMT1): A proof-of-principle phase 1b / randomised phase 2 study of afatinib penetration into brain metastases for patients undergoing neurosurgical resection, both with and without prior low-dose, targeted radiotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-04-01.
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Affiliation(s)
- RD Baird
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - N Ramenatte
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - C Watts
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - A Jonson
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - L Jones
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - H Biggs
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - E Harrison
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - I Oberg
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - G Bullen
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - M Williams
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - W Qian
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - F Gilbert
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - D Jodrell
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - C Caldas
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - K Karabatsou
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - L Dunn
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - R Jena
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - G Whitfield
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - A Chalmers
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - S Jefferies
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - S Price
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
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Price SJ, Guilfoyle M, J Jefferies S, Harris F, Oberg I, G Burnet N, Santarius T, Watts C. Development of an Integrated Subspecialist Multidisciplinary Neuro-oncology Service. BMJ Qual Improv Rep 2013; 2:bmjquality_u201857_w981. [PMID: 26734207 PMCID: PMC4652738 DOI: 10.1136/bmjquality.u201857.w981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/07/2013] [Indexed: 12/05/2022]
Abstract
Traditionally, the poor outcome for patients with malignant brain tumours led to therapeutic nihilism. In turn, this resulted in lack of interest in neurosurgical oncology subspecialisation, and less than ideal patient pathways. One problem of concern was the low rate of tumour resection. Between 1997 and 2006, 685 treated glioblastomas were identified. In the first four years only 40% of patients underwent tumour resection, rising to 55% in the last four years. Before revision of the pathway, the median length of hospital stay was 8 days, and 35% of patients received the results of their histology outside of a clinic setting. A pathway of care was established, in which all patients were discussed pre-operatively in an MDT meeting and then directed into a new surgical neuro-oncology clinic providing first point of contact. This limited the number of surgeons operating on adult glioma patients and aided recruitment into research studies. Now, three consultant neurosurgeons run this service, easily fulfilling IOG requirement to spend >50% of programmed activities in neuro-oncology. Nursing support has been critical to provide an integrated service. This model has allowed increased recruitment to clinical trials. The introduction of this service led to an increase in patients discussed pre-operatively in an MDT (66% rising to 87%; P=0.027), an increase in the rate of surgical resection (from 40% to 80%) and more patients being admitted electively (from 25% to 80%; P<0.001). There was a reduction in the median length of stay (8 days reduced to 4.5 days; P<0.001). For the cohort of GBM patients that went on to have chemoradiotherapy we improved median survival to 18 months, with 35% of patients alive at two years, comparable to international outcomes. Implementing a specialist neurosurgical oncology service begins with understanding the patient care pathway. Our patients have benefitted from the culture of subspecialisation and the excellent inter-disciplinary working relationships that have been developed.
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Guilfoyle MR, Weerakkody RA, Oswal A, Oberg I, Jeffery C, Haynes K, Kullar PJ, Greenberg D, Jefferies SJ, Harris F, Price SJ, Thomson S, Watts C. Implementation of neuro-oncology service reconfiguration in accordance with NICE guidance provides enhanced clinical care for patients with glioblastoma multiforme. Br J Cancer 2011; 104:1810-5. [PMID: 21610702 PMCID: PMC3111193 DOI: 10.1038/bjc.2011.153] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Brain tumours account for <2% of all primary neoplasms but are responsible for 7% of the years of life lost from cancer before age 70 years. The latest survival trends for patients with CNS malignancies have remained largely static. The objective of this study was to evaluate the change in practice as a result of implementing the Improving Outcomes Guidance from the UK National Institute for Health and Clinical Excellence (NICE). Methods: Patients were identified from the local cancer registry and hospital databases. We compared time from diagnosis to treatment, proportion of patients discussed at multidisciplinary team (MDT) meetings, treatment received, length of inpatient stay and survival. Inpatient and imaging costs were also estimated. Results: Service reconfiguration and implementation of NICE guidance resulted in significantly more patients being discussed by the MDT—increased from 66 to 87%, reduced emergency admission in favour of elective surgery, reduced median hospital stay from 8 to 4.5 days, increased use of post-operative MRI from 17 to 91% facilitating early discharge and treatment planning, and reduced cost of inpatient stay from £2096 in 2006 to £1316 in 2009. Patients treated with optimal surgery followed by radiotherapy with concomitant and adjuvant temozolomide achieved outcomes comparable to those reported in clinical trials: median overall survival 18 months (2-year survival 35%). Conclusions: Advancing the management of neuro-oncology patients by moving from an emergency-based system of patient referral and management to a more planned elective outpatient-based pattern of care improves patient experience and has the potential to deliver better outcomes and research opportunities.
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Affiliation(s)
- M R Guilfoyle
- Cambridge University Department of Clinical Neurosciences, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Goulding C, Cholongitas E, Nair D, Kerry A, Patch D, Akyol M, Walker S, Manas D, Mc Clure D, Smith L, Jamieson N, Oberg I, Cartwright D, Burroughs AK. Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant units in the UK. Nephrol Dial Transplant 2009; 25:960-6. [DOI: 10.1093/ndt/gfp556] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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