Neuro‐oncology practices in Australia: A Cooperative Group for Neuro‐Oncology patterns of care study

Abstract

Aims To provide data on the patterns of care in neuro‐oncology practices at Australian cancer centres over the previous 12‐month period. Methods A 5‐page questionnaire was sent to Cooperative Trials Group for Neuro‐Oncology members at 28 Australia cancer centres. The questions included access to neuro‐oncology services; treatment protocols and patterns of supportive care. Results Provision of neuro‐oncology services was consistent in metropolitan cancer centres. Treatment protocols are virtually identical for patients with an initial diagnosis of glioblastoma multiforme (GBM), with the main variation being for older or less fit patients. Most patients (70%) received chemotherapy at recurrence, most commonly modified schedule temozolomide, with half of the cancer centers offering bevacizumab. For anaplastic astrocytoma (AA), most clinicians offer radiotherapy alone but 30% would use radiotherapy with concurrent and adjuvant temozolomide. Half of clinicians continued to use prophylactic anticonvulsants; 25% do not prescribe prophylactic antibiotics during chemoradiotherapy and half would continue anti‐coagulation therapy indefinitely for thromboembolism. Conclusion This is the first Australia‐wide patterns of study of care in the management of gliomas. There is general consensus on the use of radiotherapy with concurrent and adjuvant temozolomide and the use of chemotherapy for recurrent GBM. The choice of chemotherapy at recurrence is not standard and the provision of bevacizumab is inconsistent. This survey highlights variation in the treatment of the elderly GBM and patients with AA as well as in areas of supportive care, in particular, the ongoing use of prophylactic anticonvulsants despite guidelines.

European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma

“…7,8 Dexamethasone once a day is the preferred corticosteroid based on side-effect profile, but still has a wide range of side-effects (e.g., Cushing effect, muscle weakness and diabetes mellitus), increasing with higher dose and longer duration of treatment. 9,10 A randomized controlled trial (RCT) on the use of dexamethasone in brain tumours indicated that an effective starting dose is 4 mg/day, with a maximum effective dose of 16 mg/day for symptom control.…”

Management of glioblastoma: an Australian perspective

“…The majority of patients with glioblastoma are managed in the public sector. The initial treatment of glioblastoma closely adheres to the Stupp protocol, which is a combined modality strategy consisting of maximal safe neurosurgery, then radiotherapy with concomitant and adjuvant temozolomide (11). Neurosurgery is typically performed by subspecialist brain tumor surgeons in major cities.…”

“…Following neurosurgery, most cases are presented at neuro-oncology multidisciplinary meetings, which are convened in about 81% of subspecialty cancer centers (11). This facilitates review of the integrated diagnosis of glioblastoma and treatment planning, as well as discussion of subsequent management dilemmas such as suspected pseudoprogression, the role of repeat resection and/or reirradiation at relapse.…”

“…Adjuvant radiotherapy for primary brain cancer is predominantly administered in major cities, albeit radiotherapy centers have recently been established in larger regional areas as part of a government initiative to improve cancer care access for regional and rural Australians (11). For those who need to travel from afar, subsidized patient accommodation is usually available near the treating center.…”

“…During adjuvant therapy, rural patients may participate in shared care arrangements, using a combination of local services, visiting oncologists and telehealth consults. Beyond conventional temozolomide and the alternative dose-intensity schedules, salvage options used in Australia include lomustine, bevacizumab, procarbazine, carboplatin and etoposide (11). In addition, patients may be considered for industry-sponsored or investigator-initiated trials when available.…”