How NICE guidelines are transforming services for brain cancer patients
Over 4,000 people are diagnosed with new cases of brain or central nervous system (CNS) cancer every year in the UK.
Despite its fairly low profile, brain cancer is actually the third leading cause of cancer-related death among men aged 15-54 years, and the fourth leading cause of cancer-related death among women between 15 and 34.
Management of patients with brain cancer typically involves a combination of surgery, radiotherapy and chemotherapy.
But for many years, researchers have found that patients with brain cancer have been subjected to a fragmented and uncoordinated pathway of care from diagnosis through to treatment and follow-up. In some cases this has been because resources are directed into tackling the bigger name cancers like breast and lung instead.
This prompted NICE to publish guidance in 2006 aimed at improving outcomes for people with brain and other central nervous system tumours.
This piece of guidance set out a number of key recommendations including the establishment of direct referral pathways and setting up multidisciplinary teams of neurosurgeons oncologists, pathologists and radiologists to review diagnoses and determine the best type of treatment.
Measuring the success of the NICE guideline
The guidance has since been adopted, to varying levels, by the 34 neurosurgical units across the UK, but little work has been done to measure the impact of the NICE guidance until now.
Researchers at Addenbrooke's Hospital in Cambridge have carried out a study into how the guidance has impacted on the level of care for their patients with brain cancer.
Addenbrooke's Hospital is the dedicated neurosurgical centre for the Anglian Cancer Network, which is the third largest cancer network in the UK with an estimated population of over 2.6 million people.
For the study, the researchers examined the management of patients in the 6 months immediately before the launch of the NICE guideline and compared the findings with two 6-month periods following the publication of the guidance.
The research team found a “significant increase”, from 66 to 87 per cent, in the number of patients being reviewed before surgery by a consultant-led team of healthcare professionals.
The number of patients receiving magnetic resonance imaging (MRI) scans within 72 hours following surgery shot up from 17 to 91 per cent. Increasing access to MRI scans is essential to help healthcare professionals decide whether additional treatments are needed.
Furthermore, the average length of hospital stay for patients decreased from 8 days to 4 and a half days, with waiting periods between the operation and outpatient review also significantly decreasing from 17 to 10 days.
Reducing the length of stay in hospital has generated substantial cost savings, with total expenses for patient stay in hospital and imaging reduced by almost half (from £2,096 to £1,316).
Consultant-led, cost-efficient services for patients
The research was led by Mr Mathew Guilfoyle, specialist registrar in neurosurgery from the Cambridge University Department of Clinical Neurosciences.
Mathew says: “Prior to the establishment of the pre-operative clinics, patients would be typically transferred acutely to the neurosurgical centre and remain an inpatient until their operation on an available emergency list.
“Since establishing the current service, patients are seen by a specialist neurosurgeon in the outpatient clinic to discuss the results of investigations, for example MRI scans, and the management options available.
“The process of consent for surgery is also commenced in the clinic. Patients are given a planned operating date and are admitted from home on the day of surgery.”
Commenting on cost-efficiency, Mathew says that the reductions in length of stay help to offset the cost of additional imaging and more advanced surgical treatment, such as fluorescent guided resection.
Adopt this universally to reduce length of hospital stays
Mathew believes that the redesigned system of care maximises the time patients are able to spend at home and increases their involvement in decisions regarding their own treatment.
He adds: “The model of care described in the research paper both improves patients' experience of care and the standard of treatment received, without introducing delays and remaining cost efficient.
“Our model should be adopted by other units and represents what the current standard of care should be.
“If adopted universally, we would expect length of stay to come down and more subspecialised services develop, without any increase in cost or overall time for treatment.
“With improved access to better treatment and enhanced research we would hope to see increases in survival for patients with brain tumours.”
25 August 2011