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Management
of malignant gliomas at Hartford Hospital: Patterns of care and outcomes
A.
Flowers
Hartford
Hosp, Hartford, CT
Background.
In the US 17,400 patients (pts) are diagnosed per year with primary malignant
brain tumors (BT) (SEER, 1998).
Most pts. are cared for in a community setting.
After diagnosis pts. are sent to a neurosurgeon, then a radiation oncologist,
then a medical oncologist, or hospice care.
Pts. feel there is no continuity of care and their questions and concerns are
not being addressed.
In centers where BT pts are treated by a multidisciplinary care team (MCT), pts.
are more likely to enroll in clinical studies, and the overall patient
satisfaction is higher.
The present study evaluates outcomes for pts. with malignant gliomas cared for
at Hartford Hospital (HH), in a multidisciplinary setting.
Patients
and Method. From 1996 to 2001, 117 pts. with malignant gliomas were treated
at Hartford Hospital by a MCT coordinated by a neuro-oncologist.
28 pts. had anaplastic astrocytoma (AA), 31 had anaplastic oligodendrogliomas
(AO), and 51 had glioblastoma multiforme (GBM).
Survival for these pts. is compared with a group of 47 pts. (6 AA, 2 AO, 39 GBM)
treated at Hartford Hospital in the conventional pathway (CP), either due to
patients? age, or poor prognostic factors.
Survival was also compared with national SEER data.
Results.
Survival for pts. treated by the MCT was significantly longer than for pts.
treated in CP.
Median survival for AA was 42 months (mo.) vs. 15 mo., for AO 46 mo. vs. 14 mo.,
and for GBM 10 mo. vs. 5.5 mo..
Comparative 2, 5, and 10 year survival is presented (Table).
Functional outcome for MCT managed pts was: 50% of pts. with AA, 47% of pts.
with AO and 50% of pts. with GBM were working at 1 year from diagnosis. Pts. who
survived beyond 2 years were able to maintain a good level of functioning up to
10 years for AA and AO, and up to 4 years for GBM.
Conclusions.
Multidisciplinary management of pts. with malignant gliomas does have a positive
impact on survival by providing comprehensive care, close follow-up, early
intervention at recurrence, more treatment options and a strong support system.
|
|
2
years
|
5
years
|
10
years
|
|
AA (HH MCT)
|
70%
|
37%
|
15%
|
|
AA (HH CP)
|
33%
|
0
|
0
|
|
AA (SEER)
|
44%
|
28%
|
18%
|
|
AO (HH MCT)
|
55%
|
39%
|
7%
|
|
AO (HH CP)
|
0
|
0
|
0
|
|
AO (SEER)
|
57%
|
34%
|
N/A
|
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GBM (HH MCT)
|
14%
|
5%
|
0
|
|
GBM (HH CP)
|
6%
|
0
|
0
|
|
GBM (SEER)
|
8%
|
3%
|
2%
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© Copyright 2003
American Society of Clinical Oncology All rights
reserved worldwide
Source: http://www.asco.org/ac/1,1003,_12-002489-00_18-002003-00_19-00100543-00_29-00A,00.asp?cat=CNS+Tumors&parent=
Central+Nervous+System+Tumors&returnpid=2325&SubCat_ID=4
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