BRAIN TUMOUR PATIENTS MUST BE LEGALLY TREATED BY MULTIDISCIPLINARY TEAMS

By Dr David Levy, Consultant Oncologist, Sheffield, UK.

By the end of 2010 it is expected in England that all patients with suspected brain tumours benign or malignant would be treated by designated specialist multidisciplinary teams. It is expected that no patients will be treated outside these specialist teams.

This is due to guidance issued in 2006 by the National Institute for Health and Clinical Excellence. This guidance recommended that any organisation that commissions brain tumour care within England should only buy it from these teams by end 2010.

Currently, in England, there are more than 150 hospitals that may admit patients with symptoms of a brain tumour. There are 28 neurosurgical centers and more than 50 radiotherapy centers. There can be poor coordination of care between these services, which is similar to much of the rest of the world.

The aim is to ensure all patients benefit from early intervention of a multidisciplinary team (including neurosurgeons, oncologists, neurologists, neuropathologists, neuroradiologists and specialist nurses) to ensure they are diagnosed and receive appropriate care, within an agreed treatment plan, as quickly as possible. All patients will have access to a specialist nurse.

Within the teams there are restrictions as to which surgeons would be able to operate on brain tumour patients in the future. The intention is to ensure that only surgeons who spend the majority of their working time looking after brain tumour patients are involved in their care. Thus surgeons who undertake the occasional procedure would not be able to do so routinely.

There will be multidisciplinary team meetings, where the team will come together on a weekly basis, to discuss all patients either diagnosed or with a suspected brain tumour including cerebral secondaries. There will other meetings to discuss patients with pituitary tumours, skull base tumours and spinal tumours.

Work has commenced on national protocols for the diagnosis and treatment of rarer brain tumours, including CNS lymphoma, adult Medulloblastoma, optic nerve gliomas and pineal tumours. There will be explicit close links to Principal Treatment Centres for Paediatric and Young Adult cancers.

The impact of this has been shown, in other cancers, to improve the quality of patient care, reduce post-operative mortality and result in better coordination of care as well as reducing stress amongst specialists caring for these patients.

It is also likely that this would cause an increase in the number of patients who are offered entry into trials.

Data will be collected on all patients diagnosed with a brain tumour, their treatment and outcomes, including in the next few years patients reporting the quality of their care.

In England it has rapidly become obvious that there are a significant number of patients who have not been identified previously on cancer registries. These are patients who have been diagnosed with a brain tumour but not undergone any surgery or radiotherapy. This probably accounts for an extra 30 percent of patients with grade IV disease.

Funding of this improvement to the health service would be in the order of 30 million pounds a year. This will be for the extra time for the meetings as well as the extra specialist nurses, neuroradiologists and neuropathologists required.

There will also be funding to ensure that patients have rapid access to rehabilitation, wherever they live.