Multi-disciplinary Care for Brain Cancer

Overseen By Alissa A Thomas, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Vermont Medical Center

Disqualifiers: Under 18, Pregnant

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6-12 months

40 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment 'Multi-disciplinary Care for Brain Cancer'?

Research shows that a multidisciplinary approach, where multiple specialists work together, improves patient outcomes in various cancers, including brain cancer. This approach allows for comprehensive care and better coordination, which can lead to improved quality of life and treatment success. ^{1 2 3 4 5}

Is multi-disciplinary care generally safe for humans?

Research shows that involving a pharmacist in a multi-disciplinary care team can help prevent adverse drug events (harmful reactions to medications) in adults, suggesting that this approach is generally safe and can reduce medication-related risks. ^{6 7 8 9 10}

How is the treatment 'Intensive Multi-disciplinary Care' for brain cancer different from other treatments?

Intensive Multi-disciplinary Care for brain cancer is unique because it involves a team of specialists from different fields working together to create a comprehensive treatment plan, allowing patients to see multiple providers on the same day. This approach aims to improve coordination and decision-making, which can lead to better patient outcomes compared to traditional care where specialists work independently. ^{1 3 11 12 13}

What is the purpose of this trial?

This is a health services intervention study aimed at understanding the impact of intensive multi-disciplinary care compared with standard care on patient-reported symptom outcomes and prognostic awareness in patients with brain metastases.

Eligibility Criteria

This clinical trial is for patients with brain metastases, which are cancerous tumors that have spread to the brain. Participants should be those who require a new approach to care and are currently receiving standard treatment.

Inclusion Criteria

I can complete questionnaires in English.

I have been newly diagnosed with brain metastases from a solid tumor.

I can accurately report my own health data.

Exclusion Criteria

Pregnant patients are not eligible.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either standard of care or intensive multi-disciplinary care for brain metastases

6-12 months

Follow-up

Participants are monitored for symptom burden, feasibility, and survival outcomes

6-12 months

Treatment Details

Interventions

• Health Services Intervention

Trial Overview The study is testing whether an intensive multi-disciplinary care approach can improve patient-reported symptoms and awareness of their prognosis compared to standard care in individuals with brain metastases.

Participant Groups

Group I: Multidisciplinary Care Experimental Treatment 1 Intervention

Group II: Standard of Care Active Control 1 Intervention

Who Is Running the Clinical Trial?

University of Vermont Medical Center

Lead Sponsor

Trials

46

Recruited

25,900+

Findings from Research

The implementation of a multidisciplinary clinic (MDC) for neuro-oncology care improved overall survival for patients with CNS metastatic disease, with median survival increasing from 248 days before MDC to 315 days after (P<0.027).

The MDC also enhanced follow-up consistency across different specialties, addressing discrepancies in follow-up imaging that existed prior to its implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuro-oncology Multidisciplinary Clinic and Improvements in Patient Outcome. Kubicek, GJ., Yocum, N., Thomas, C., et al.[2021]

The guidelines for managing adults with malignant cerebral glioma were developed by a diverse working group, ensuring that both medical effectiveness and patient perspectives were considered, which can lead to improved patient care.

The document outlines key stages of care, from diagnosis to treatment planning and follow-up, and includes an audit package for treatment centers to evaluate their practices against these standards, highlighting the importance of continuous improvement in patient management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Good practice in the management of adults with malignant cerebral glioma: clinical guidelines. Working Group, Royal College of Physicians. Davies, E., Hopkins, A.[2019]

The reorganization of the Belgian oncology care system has led to the implementation of standardized care programs and the establishment of multidisciplinary oncology consultations (MOC), which are essential for developing comprehensive treatment plans for cancer patients.

The success of the MOC approach is driven by both legal requirements for reimbursement and the medical community's commitment to improving patient outcomes through collaboration among specialists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How to implement the multidisciplinary approach in prostate cancer management: the Belgian model. Van Belle, S.[2022]

The study analyzed 12 multidisciplinary team meetings (MDTMs) involving various cancer specialists and found no significant differences in their functioning based on tumor type, except for one non-disease specific meeting that lacked electronic organizational tools.

Effective decision-making in MDTMs was largely influenced by the availability of case-based information and the presence of relevant specialists, highlighting the importance of structured coordination and teamwork across all tumor types.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Team functioning across different tumour types: Insights from a Swiss cancer center using qualitative and quantitative methods. Hitz, F., Ribi, K., Grote, G., et al.[2022]

The care for breast carcinoma has evolved into a multidisciplinary approach, integrating various medical specialists to enhance treatment outcomes.

Patients are encouraged to have a 'reference physician' who coordinates communication among the specialists and the general practitioner, ensuring cohesive management of their care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Multidisciplinary approach in breast cancer care]. Petit, T.[2009]

In a 5-month study of 249 oncology patients, 22.9% were admitted to the intensive care unit due to adverse drug events, primarily linked to antineoplastics, analgesics, and anticoagulants.

These adverse drug events led to an average ICU stay of 6.2 days and a mortality rate of 28.1%, highlighting their serious impact on patient health and resulting in significant healthcare costs, averaging $11,692 per patient.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse drug events resulting in admission to the intensive care unit in oncology patients: Incidence, characteristics and associated cost. Nazer, LH., Eljaber, R., Rimawi, D., et al.[2013]

Multidisciplinary care teams that include pharmacists are effective in preventing adverse drug events (ADEs), with the most common intervention being structured medication review meetings involving physicians, pharmacists, and nurses.

The majority of interventions targeted elderly patients, particularly those in nursing homes, highlighting the need for comprehensive medication assessments in this vulnerable population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intervention of pharmacist included in multidisciplinary team to reduce adverse drug event: a qualitative systematic review. Zaij, S., Pereira Maia, K., Leguelinel-Blache, G., et al.[2023]

Approximately 5% of unplanned hospital admissions in the Netherlands are linked to adverse drug events (ADEs), with 40-46% of these being potentially preventable, highlighting a significant public health issue.

The study identified seven major ADEs related to ten drug classes, with gastrointestinal bleeding being the most common, and developed 43 recommendations (9 general and 34 drug-specific) aimed at reducing these preventable admissions through computerized drug safety alerts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting outpatient drug safety: recommendations of the Dutch HARM-Wrestling Task Force. Warlé-van Herwaarden, MF., Kramers, C., Sturkenboom, MC., et al.[2021]

Adverse events in neurosurgery are common but reporting is inconsistent due to varying definitions and data collection methods, which has hindered quality improvement efforts in the field.

The National Neurosurgery Quality and Outcomes Database is a new initiative that collects prospective, multi-institutional data on neurosurgical outcomes, aiming to provide reliable data for benchmarking and developing strategies to reduce adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in neurosurgery and their relationship to quality improvement. Ziewacz, JE., McGirt, MJ., Chewning, SJ.[2015]

This study aims to assess the frequency and types of adverse events in Australian pediatric care by reviewing 6000-8000 medical records of children under 16 years from various healthcare settings during 2012 and 2013.

The research will utilize a modified version of the Global Trigger Tool for data collection, which is a systematic approach to identifying potential safety issues in healthcare, highlighting the importance of improving patient safety in children's healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CareTrack Kids-part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review. Hibbert, PD., Hallahan, AR., Muething, SE., et al.[2019]

Neuro-oncology multidisciplinary cancer meetings (MCMs) involve a wide range of specialists and are crucial for discussing complex cases, with 100% participation from neuro-oncologists, neurosurgeons, and radiation oncologists, and high perceived value for clinical decision-making (94%) and education (89%).

There is significant variability in how MCMs are prepared for and documented, with only 13% of meetings recorded in medical records, and a notable uncertainty regarding the definition and use of molecular tumor boards, despite 38% of centers utilizing them.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of tumor board conferences in neuro-oncology: a nationwide provider survey. Snyder, J., Schultz, L., Walbert, T.[2018]

Patients with high-grade glioma managed in a formal neuro-oncology multidisciplinary tumor clinic (MTC) showed significantly better clinical quality outcomes, including higher rates of post-operative imaging and adjuvant chemotherapy use compared to those managed through a traditional referral pattern.

The median survival for patients treated in the MTC was 18.7 months, compared to 11.9 months for those in the non-MTC group, suggesting that a multidisciplinary approach may enhance patient outcomes, although the difference in survival was not statistically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvements in quality of care resulting from a formal multidisciplinary tumour clinic in the management of high-grade glioma. Back, MF., Ang, EL., Ng, WH., et al.[2022]

Recent advancements in brain tumor treatment emphasize the importance of accurate diagnosis through imaging and neuropathology, combined with a multidisciplinary approach involving neurosurgery, medical oncology, and supportive care.

The establishment of specialized neurooncologic teams and centers of excellence is crucial for enhancing treatment quality, as they integrate various healthcare professionals, including nurses and therapists, to address the comprehensive needs of patients and their families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Editorial: Brain tumour treatment: the concept of inter- and multidisciplinary treatment. Grisold, W., Oberndorfer, S., Hitzenberger, P.[2018]

References

1. United States pubmed.ncbi.nlm.nih.gov

Neuro-oncology Multidisciplinary Clinic and Improvements in Patient Outcome. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Good practice in the management of adults with malignant cerebral glioma: clinical guidelines. Working Group, Royal College of Physicians. [2019]

3. England pubmed.ncbi.nlm.nih.gov

How to implement the multidisciplinary approach in prostate cancer management: the Belgian model. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Team functioning across different tumour types: Insights from a Swiss cancer center using qualitative and quantitative methods. [2022]

5. France pubmed.ncbi.nlm.nih.gov

[Multidisciplinary approach in breast cancer care]. [2009]

6. England pubmed.ncbi.nlm.nih.gov

Adverse drug events resulting in admission to the intensive care unit in oncology patients: Incidence, characteristics and associated cost. [2013]

7. England pubmed.ncbi.nlm.nih.gov

Intervention of pharmacist included in multidisciplinary team to reduce adverse drug event: a qualitative systematic review. [2023]

8. New Zealand pubmed.ncbi.nlm.nih.gov

Targeting outpatient drug safety: recommendations of the Dutch HARM-Wrestling Task Force. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Adverse events in neurosurgery and their relationship to quality improvement. [2015]

10. England pubmed.ncbi.nlm.nih.gov

CareTrack Kids-part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

The role of tumor board conferences in neuro-oncology: a nationwide provider survey. [2018]

12. Singapore pubmed.ncbi.nlm.nih.gov

Improvements in quality of care resulting from a formal multidisciplinary tumour clinic in the management of high-grade glioma. [2022]

13. Austria pubmed.ncbi.nlm.nih.gov

Editorial: Brain tumour treatment: the concept of inter- and multidisciplinary treatment. [2018]