Assessing and Treating Patients with Brain Tumors: A Team Approach

The medical and surgical management of brain tumors requires the kind of team approach that is available at the Brain Tumor Center at the University of Cincinnati Neuroscience Institute. Ongoing collaboration among expert team members, combined with state-of-the-art technology, ensures the best possible treatment for patients with primary or metastatic brain tumors.

The UC Brain Tumor Center team includes multiple physicians, a nurse practitioner, and nurses. The physicians include specialists in radiation oncology, neurosurgery, neuro-oncology, otolaryngology, neuro-ophthalmology, physical medicine and rehabilitation, restorative medicine, neuropathology, and neuroradiology.

The entire process of assessing and treating a patient with a brain tumor typically begins when a patient sends clinical records, x-rays, or MRI scans to be reviewed by the Brain Tumor Center team. The team then conducts a preliminary review to determine which of the specialists the patient should see.

Each Wednesday, patients who are ready to move forward are addressed at the Brain Tumor Center’s Multidisciplinary Tumor Board Conference. The brain tumor team gathers at 10 a.m. for this weekly neuro-oncology conference, a fascinating roundtable featuring about 15 different physician specialists, including representatives from neurosurgery, radiation oncology, neuro-oncology, otolaryngology-head and neck surgery, neuro-ophthalmology, endocrinology, neuropathology, neuroradiology, and restorative medicine. During the conference, the cases of individual patients are presented one after another.

A neuroradiologist begins each presentation by reviewing the patient’s films and stating the type of tumor the patient has, whether it has recurred, and whether any other abnormality is present. If pathology slides are available from a previous surgery, a neuropathologist presents them and explains the findings. Then, in a systematic fashion, the Tumor Board moderator solicits recommendations from representatives of each of the Center’s primary specialties. A neurosurgeon advises whether surgical intervention is possible; a radiation oncologist advises whether the patient should receive radiation; and a neuro-oncologist states whether chemotherapy is appropriate. At the conclusion of the discussion, a recommendation is always given: a strategy for treatment or a decision to perform another test. On many occasions, more than one option is presented.

The value of bringing together so many experts cannot be overestimated. In several instances, the team has determined that patients who were told they had a brain tumor in fact did not have a tumor. These patients clearly benefited from the combined expertise of many specialists, rather than having their treatment hinge on a single radiologist’s report or an individual neurosurgeon’s decision, made in isolation, in a vacuum.

After developing potential management plans for numerous patients, the team goes directly, almost seamlessly, to the Neuro-Oncology Multidisciplinary Clinic, which is held at 1 p.m. on Wednesdays at the Barrett Center at University Hospital and at 9 a.m. on Fridays at University Pointe in West Chester, Ohio. At these clinics patients have the opportunity to see a neurosurgeon, a radiation oncologist, a neuro-oncologist, or a nurse specially trained in patient education without ever changing exam rooms.

The Multidisciplinary Clinic is of great value for patients who come from a five-state area, because their course of treatment may or may not mirror the diagnoses and assumptions of their referring physicians. For example, if an out-of-town neurosurgeon sends a patient to the Brain Tumor Center for potential surgery, but the center’s experts decide the patient is a candidate for radiation, the patient can see a radiation oncologist that day instead of being asked to make a return trip.

In summary, a team approach to brain tumors helps ensure the best possible treatment strategy and outcome for patients. Those who seek treatment from the UC Brain Tumor Center’s team have access not only to a first or second opinion, but also to a fourth, fifth, and sixth. In such a setting—with so many minds engaged in a patient’s well being—all creative options will most certainly be explored. As a result, patients need not worry about the quality of their care. They can focus instead on their families, their futures, and their health.