A new model of care for patients with central nervous system cancers.

Abstract

e18029 Background: Patients (pts) with primary or metastatic central nervous system (CNS) cancers often have multiple physical, psychosocial, and spiritual needs. Neurological impairments can transform relationship dynamics as loved ones become caregivers. These issues are difficult to address within a single outpatient oncology clinic. Methods: The Neurological Multidisciplinary Care Clinic (MdCC) at Memorial Sloan Kettering Cancer Center was a pilot study from 08/2017 to 01/2019 to foster a new model of care for complex pts with CNS cancers to identify and address their needs. The MdCC team, comprised of a neurologist, nurse, physiatrist, physical therapist, social worker(SW), case manager(CM), dietitian(RD), and chaplain. During a 3-hour visit, MdCC providers saw each pt/caregiver. Since 11/2017 participants completed validated surveys on unmet needs, financial strain, and home equipment prior to their visit and satisfaction surveys afterward. Descriptive statistics were used to analyze results. Results: Seventy-six pts were seen: 37 were female, median age 60. Of these 76 pts, 63 had primary CNS cancers; glioblastoma (51%) and high-grade glioma (HGG) (29%). Fifty-five were receiving cancer-directed therapy at the time of MdCC. Over 70% had never seen a SW, CM, RD, or physiatrist prior to MdCC. Pts’ most commonly reported need was “not being able to do the things I used to do”; for caregivers it was “I need my partner to have an ongoing CM.” Seventy-four pts (97%) received symptom management recommendations. Prognosis/coping with cancer was discussed with 70 (92%) which increased signed health care proxy forms by 11% and DNR orders by 3%. New/updated physical therapy was ordered for 48 pts (61%), orthotics for 8 (10%), and new equipment for 12 (15%). Five pts were referred to a food assistance program. Forty-five pts completed a satisfaction survey; of these, 96% were highly satisfied, and would recommend MdCC to others. Conclusions: Pts’/caregivers’ unmet needs were effectively identified and addressed in this new model, and an emphasis on supportive and coordinated care contributed to high pt/caregiver satisfaction. We therefore propose to offer this clinic for all pts with HGG to improve pts’ well-being, quality of care, and increase pt/caregiver satisfaction.