INNV-26. SERVICE RECONFIGURATION INTO AN URGENT ELECTIVE PATHWAY FOR THE MANAGEMENT OF GLIOBLASTOMA PATIENTS IMPROVES OUTCOMES, COSTS AND PATIENT EXPERIENCE AND ADJUNCT USE: A SINGLE CENTRE SIX YEAR REVIEW

Abstract

Abstract BACKGROUND Glioblastomas (GB) are grade four gliomas, the most common form of neoplasms arising in the brain. GBs are known for their aggressiveness; despite widespread research, limited advances have been made to improve survival. Between 2014–2019, a service reconfiguration for suspected GB referrals within our centre has been achieved. We have gone from a predominantly emergency admission and surgery based service for GB, to an urgent elective admission pathway. This is backed by weekly MDTs, neuro-oncology specialist led clinics, with imaging and pre-assessment clinic as part of a one-stop-shop model. Improved planning through elective admissions has also helped us achieve increased use of intra-operative adjuncts, including neuro-monitoring and the use of 5-ALA. The aim of this study is to describe a single centre experience of improvements made across six years through a combination of service reconfiguration and an increase use of intra-operative adjuncts. METHODS Patients with histological confirmed, primarily diagnosed GBs between 01/01/2014 and 31/12/2019 were extracted from the pathology database. Information including survival, treatment (surgical, oncological) and use of adjunct, admission status, length of stay (LOS), extent of resection and surgical complications were extracted manually. Inpatient admission costs were estimated. RESULTS From 2014 to 2019, we achieved an increase in elective admissions (28.1% to 90.3%, p< 0.001), which has led to a greater proportion of patients undergoing resective surgery (68.4% to 81.9%, p= 0.041), reduction in median length of stay (9 to 3 days, p < 0.001) and deceased overall costs. An increased use of intra-operative adjuncts has improved the proportion of total and gross resections (p< 0.001). CONCLUSIONS A switch from emergency to a MDT-based, urgent pathway with increased use of intra-operative adjuncts has resulted in improved technical outcomes and cost savings for the trust. This change has high potential to improve survival in patients on further follow-up.