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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how intensive care from a team of specialists affects individuals with brain cancer that has spread from other parts of the body. Researchers aim to determine if this approach, known as Health Services Intervention, improves symptoms and enhances patients' understanding of their condition compared to standard care. Participants will either continue with regular care or receive care from a diverse medical team. This trial may suit individuals newly diagnosed with brain metastases who can communicate in English. As an unphased trial, it offers a unique opportunity to contribute to understanding how specialized care can improve patient outcomes.

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 prior data suggests that this health services intervention is safe?

Research has shown that when a team of different specialists collaborates to treat brain cancer, patient outcomes improve. This team-based approach is under study to assess its effectiveness and safety. Although specific safety data for this method is lacking, it is generally well-tolerated because it emphasizes collaboration rather than introducing new drugs or treatments.

Reports of negative effects from this team approach are absent. In fact, it is associated with better patient outcomes, indicating it is a safe option. The study examines how this type of care affects patient symptoms and understanding, offering participants the chance to contribute to potential improvements in care for many people. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the multidisciplinary care for brain cancer because it offers a more integrated approach compared to the standard treatment options like surgery, radiation, and chemotherapy. Unlike these traditional methods that often focus on isolated aspects of treatment, multidisciplinary care combines the expertise of various specialists, such as oncologists, neurologists, and supportive care teams, to address the patient's overall needs. This comprehensive approach aims to improve not only survival rates but also quality of life by considering the patient's holistic health and well-being. By coordinating different areas of medical care, this method could lead to more personalized and effective treatment plans for individuals battling brain cancer.

What evidence suggests that this trial's treatments could be effective for brain cancer?

This trial will compare Standard of Care with Multidisciplinary Care for brain cancer patients. Research has shown that collaboration among specialists can improve outcomes for patients with various cancers, including brain cancer. Patients receiving care from a team of specialists have demonstrated improvements in mobility and cognitive function. One study found this team approach particularly beneficial for managing brain tumors. Specifically, brain tumor survivors who received such care experienced improvements, with some benefits lasting up to six months. Overall, evidence supports that involving different experts can enhance treatment effectiveness for brain cancer patients. ^{3 6 7 8 9}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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]

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]

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 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]

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]

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]

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]

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]

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