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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

Service reconfiguration supports research for patient benefit. Our ability to interrogate each stage of the patient journey with an array of screening, diagnostic and analytical tools is unique. This results in a highly integrated research infrastructure capable of delivering tangible results evidenced by the number of clinical studies into which we are recruiting patients. NB: RT in Meningioma, MALTINGS and GALA-5 are all led by Cambridge PIs.
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fig5: Service reconfiguration supports research for patient benefit. Our ability to interrogate each stage of the patient journey with an array of screening, diagnostic and analytical tools is unique. This results in a highly integrated research infrastructure capable of delivering tangible results evidenced by the number of clinical studies into which we are recruiting patients. NB: RT in Meningioma, MALTINGS and GALA-5 are all led by Cambridge PIs.

Mentions: More recently, fluorescence-guided surgical resection has been introduced and an increasing proportion of patients are receiving carmustine chemotherapy wafer implants after debulking (Westphal et al, 2003; Stummer et al, 2006). The improvements made in the system of care will ensure that all patients eligible for these advanced interventions are offered current best treatment. The introduction of a dedicated referral pathway, specialist MDT meetings and routine post-operative imaging has established a robust mechanism for rigorous surgical, radiological and chemotherapy audit and provides the necessary platform for continued research and recruitment into clinical trials (Figure 5). The latter benefit is evidenced by the opening of a NIHR-funded observational study imaging tumour invasion (MALTING Study; UKCRN 8596) and a CRUK/SDBTT funded phase 1 study combining intraoperative chemotherapy with fluorescence-guided resection (GALA-5; CRUK/10/009). Improved access to tissue has enabled us to refine a protocol for efficient derivation of stem-like tumour initiating cells from GBM and to develop pre-clinical animal models for drug development and testing (Fael Al-Mayhani et al, 2009).


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)

Service reconfiguration supports research for patient benefit. Our ability to interrogate each stage of the patient journey with an array of screening, diagnostic and analytical tools is unique. This results in a highly integrated research infrastructure capable of delivering tangible results evidenced by the number of clinical studies into which we are recruiting patients. NB: RT in Meningioma, MALTINGS and GALA-5 are all led by Cambridge PIs.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Service reconfiguration supports research for patient benefit. Our ability to interrogate each stage of the patient journey with an array of screening, diagnostic and analytical tools is unique. This results in a highly integrated research infrastructure capable of delivering tangible results evidenced by the number of clinical studies into which we are recruiting patients. NB: RT in Meningioma, MALTINGS and GALA-5 are all led by Cambridge PIs.
Mentions: More recently, fluorescence-guided surgical resection has been introduced and an increasing proportion of patients are receiving carmustine chemotherapy wafer implants after debulking (Westphal et al, 2003; Stummer et al, 2006). The improvements made in the system of care will ensure that all patients eligible for these advanced interventions are offered current best treatment. The introduction of a dedicated referral pathway, specialist MDT meetings and routine post-operative imaging has established a robust mechanism for rigorous surgical, radiological and chemotherapy audit and provides the necessary platform for continued research and recruitment into clinical trials (Figure 5). The latter benefit is evidenced by the opening of a NIHR-funded observational study imaging tumour invasion (MALTING Study; UKCRN 8596) and a CRUK/SDBTT funded phase 1 study combining intraoperative chemotherapy with fluorescence-guided resection (GALA-5; CRUK/10/009). Improved access to tissue has enabled us to refine a protocol for efficient derivation of stem-like tumour initiating cells from GBM and to develop pre-clinical animal models for drug development and testing (Fael Al-Mayhani et al, 2009).

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