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Implementation of neuro-oncology service reconfiguration in accordance with NICE guidance provides enhanced clinical care for patients with glioblastoma multiforme.

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 - Br. J. Cancer (2011)

Bottom Line: 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).We compared time from diagnosis to treatment, proportion of patients discussed at multidisciplinary team (MDT) meetings, treatment received, length of inpatient stay and survival.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.

View Article: PubMed Central - PubMed

Affiliation: Cambridge University Department of Clinical Neurosciences, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.

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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Related in: MedlinePlus

Change in management and outcome. Proportions of patients receiving tumour debulking surgery (vs biopsy) and adjuvant radiotherapy (RT) and chemotherapy (CT) in the two 5-year periods of the study ((A) all comparisons with χ2-test, P<0.05). Kaplan–Meier curves for the two study periods (B). Comparison with log-rank test shows significant improvement in survival (P<0.001).
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fig2: Change in management and outcome. Proportions of patients receiving tumour debulking surgery (vs biopsy) and adjuvant radiotherapy (RT) and chemotherapy (CT) in the two 5-year periods of the study ((A) all comparisons with χ2-test, P<0.05). Kaplan–Meier curves for the two study periods (B). Comparison with log-rank test shows significant improvement in survival (P<0.001).

Mentions: The first (1997–2001) and latter (2002–2006) halves of the study period were compared to assess changes in practice and outcome (Figure 2). There was no change in patient age (mean 61.5 vs 59.8 years, t=1.95, P>0.05) or gender (male: 58.9% vs 63.7%, χ2=1.7, P>0.05). However, there were significant increases in the proportions of patients receiving debulking surgery (39.9% vs 54.8%, χ2=13.8, P<0.001), adjuvant radiotherapy (59.4% vs 66.8%, χ2=3.9, P=0.048) and chemotherapy (10.4% vs 28.0%, χ2=20.2, P<0.001; Figure 2A). There was a significant improvement in survival between the two 5-year periods (4.4 vs 5.8 months, P<0.001; Figure 2B). Cox-regression analysis showed the independent predictors of survival were age (Hazard ratio (95%CI): 1.03 (1.02–1.04), P<0.001), debulking surgery (HR 0.80 (0.67–0.94), P<0.01), radiotherapy (HR 0.43 (0.36–0.51), P<0.001) and chemotherapy (HR 0.59 (0.46–0.75), P<0.01). Gender and year of diagnosis were not significantly associated with survival in the model.


Implementation of neuro-oncology service reconfiguration in accordance with NICE guidance provides enhanced clinical care for patients with glioblastoma multiforme.

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 - Br. J. Cancer (2011)

Change in management and outcome. Proportions of patients receiving tumour debulking surgery (vs biopsy) and adjuvant radiotherapy (RT) and chemotherapy (CT) in the two 5-year periods of the study ((A) all comparisons with χ2-test, P<0.05). Kaplan–Meier curves for the two study periods (B). Comparison with log-rank test shows significant improvement in survival (P<0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111193&req=5

fig2: Change in management and outcome. Proportions of patients receiving tumour debulking surgery (vs biopsy) and adjuvant radiotherapy (RT) and chemotherapy (CT) in the two 5-year periods of the study ((A) all comparisons with χ2-test, P<0.05). Kaplan–Meier curves for the two study periods (B). Comparison with log-rank test shows significant improvement in survival (P<0.001).
Mentions: The first (1997–2001) and latter (2002–2006) halves of the study period were compared to assess changes in practice and outcome (Figure 2). There was no change in patient age (mean 61.5 vs 59.8 years, t=1.95, P>0.05) or gender (male: 58.9% vs 63.7%, χ2=1.7, P>0.05). However, there were significant increases in the proportions of patients receiving debulking surgery (39.9% vs 54.8%, χ2=13.8, P<0.001), adjuvant radiotherapy (59.4% vs 66.8%, χ2=3.9, P=0.048) and chemotherapy (10.4% vs 28.0%, χ2=20.2, P<0.001; Figure 2A). There was a significant improvement in survival between the two 5-year periods (4.4 vs 5.8 months, P<0.001; Figure 2B). Cox-regression analysis showed the independent predictors of survival were age (Hazard ratio (95%CI): 1.03 (1.02–1.04), P<0.001), debulking surgery (HR 0.80 (0.67–0.94), P<0.01), radiotherapy (HR 0.43 (0.36–0.51), P<0.001) and chemotherapy (HR 0.59 (0.46–0.75), P<0.01). Gender and year of diagnosis were not significantly associated with survival in the model.

Bottom Line: 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).We compared time from diagnosis to treatment, proportion of patients discussed at multidisciplinary team (MDT) meetings, treatment received, length of inpatient stay and survival.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.

View Article: PubMed Central - PubMed

Affiliation: Cambridge University Department of Clinical Neurosciences, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.

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.

Show MeSH
Related in: MedlinePlus