Abstract
Delivery of highly sophisticated, and subspecialised, management protocols for glioblastoma in low volume rural and regional areas creates potential issues for equivalent quality of care. This study aims to demonstrate the impact on clinical quality indicators through the development of a novel model of care delivering an outsourced subspecialised neuro-oncology service in a regional centre compared with the large volume metropolitan centre. Three hundred and fifty-two patients with glioblastoma were managed under the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) Protocol, and survival outcome was assessed in relation to potential prognostic factors and the geographical site of treatment, before and after opening of a regional cancer centre. The median overall survival was 17 months (95% CI: 15.5–18.5), with more favourable outcome with age less than 50 years (p < 0.001), near-total resection (p < 0.001), Eastern Cooperative Oncology Group (ECOG) Performance status 0, 1 (p < 0.001), and presence of O-6 methylguanine DNA methyltransferase (MGMT) methylation (p = 0.001). There was no difference in survival outcome for patients managed at the regional centre, compared with metropolitan centre (p = 0.35). Similarly, no difference was seen with clinical quality process indicators of clinical trial involvement, rates of repeat craniotomy, use of bevacizumab and re-irradiation. This model of neuro-oncology subspecialisation allowed equivalent outcomes to be achieved within a regional cancer centre compared to large volume metropolitan centre.
Highlights
Since the publication of the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) Phase III Trial, in 2005 [1], there has been a greater emphasis on optimizing outcome
This study, updated in 2009, demonstrated that the addition of an oral chemotherapy drug, Temozolomide (TMZ), to standard radiation therapy (RT) resulted in an increase of median survival from 10.8 months to 14.6 months, and a doubling of 2-year survival [2]
This study explores the outcomes for glioblastoma following the development of a highly-subspecialised model of care for a neuro-oncology service in a regional area of Australia utilising outsourced resources linked to a large metropolitan centre
Summary
Brain Sci. 2018, 8, 186 therapy (IMRT), exploration of molecular prognostic factors, and targeted therapies, have further improved the median survival of patients [3,4]. With specialised neuro-oncology tumour boards, molecular analysis, novel diagnostic MRI-PET imaging, and demand for more tumour specific supportive care services, has increased the infrastructure demands required to manage a comprehensive neuro-oncology practice. This may not be reproducible or efficient resource allocation for low population centres, such as rural or regional areas
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