Abstract
Aims
Glioblastoma multiforme (GBM) is an aggressive brain malignancy. Performance status is an important prognostic factor but is subjectively evaluated, resulting in inaccuracy. Objective ...markers of frailty/physical condition, such as measures of skeletal muscle mass can be evaluated on cross-sectional imaging and is associated with cancer survival. In GBM, temporalis muscle has been identified as a skeletal muscle mass surrogate and a prognostic factor. However, current manual muscle quantification is time consuming, limiting clinical adoption. We previously developed a deep learning system for automated temporalis muscle quantification, with high accuracy (Dice coefficient 0.912), and showed muscle cross-sectional area is independently significantly associated with survival in GBM (HR 0.380). However, it required manual selection of the temporalis muscle-containing MRI slice. Thus, in this work we aimed to develop a fully automatic deep-learning system, using the eyeball as an anatomic landmark for automatic slice selection, to quantify temporalis and validate on independent datasets.
Method
3D brain MRI scans were obtained from four datasets: our in-house glioblastoma patient dataset, TCGA-GBM, IVY-GAP and REMBRANDT. Manual eyeball and temporalis segmentations were performed on 2D MRI images by two experienced readers. Two neural networks (2D U-Nets) were trained, one to automatically segment the eyeball and the other to segment the temporalis muscle on 2D MRI images using Dice loss function. The cross sectional area of eyeball segmentations were quantified and thresholded, to select the superior orbital MRI slice from each scan. This slice underwent temporalis segmentation, whose cross sectional area was then quantified. Accuracy of automatically predicted eyeball and temporalis segmentations were compared to manual ground truth segmentations on metrics of Dice coefficient, precision, recall and Hausdorff distance. Accuracy of MRI slice selection (by the eyeball segmentation model) for temporalis segmentation was determined by comparing automatically selected slices to slices selected manually by a trained neuro-oncologist.
Results
398 images from 185 patients and 366 images from 145 patients were used for the eyeball and temporalis segmentation models, respectively. 61 independent TCGA-GBM scans formed a validation cohort to assess the performance of the full pipeline. The model achieved high accuracy in eyeball segmentation, with test set Dice coefficient of 0.9029 ± 0.0894, precision of 0.8842 ± 0.0992, recall of 0.9297 ± 0.6020 and Hausdorff distance of 2.8847 ± 0.6020. High segmentation accuracy was also achieved by the temporalis segmentation model, with Dice coefficient of 0.8968 ± 0.0375, precision of 0.8877 ± 0.0679, recall of 0.9118 ± 0.0505 and Hausdorff distance of 1.8232 ± 0.3263 in the test set. 96.1% of automatically selected slices for temporalis segmentation were within 2 slices of the manually selected slice.
Conclusion
Temporalis muscle cross-sectional area can be rapidly and accurately assessed from 3D MRI brain scans using a deep learning-based system in a fully automated pipeline. Combined with our and others’ previous results that demonstrate the prognostic significance of temporalis cross-sectional area and muscle width, our findings suggest a role for deep learning in muscle mass and sarcopenia screening in GBM, with the potential to add significant value to routine imaging. Possible clinical applications include risk profiling, treatment stratification and informing interventions for muscle preservation. Further work will be to validate the prognostic value of temporalis muscle cross sectional area measurements generated by our fully automatic deep learning system in the multiple in-house and external datasets.
Abstract
Aims
Extent of resection is associated with better survival in patients with glioblastoma. Numerous surgical adjuncts can be used to achieve maximal safe resection - including ...fluorescence-guidance with 5-aminolevulinic acid (5-ALA), neuronavigation, intraoperative ultrasound (IoUS), intra-operative MRI (iMRI), tractography, electrophysiological monitoring and awake surgery. We evaluated the availability, use and operative aim and success associated with these adjuncts.
Method
This is a prospective cohort study of 27 of 31 neurosurgical centres in the UK and Ireland from 6 January to 19 March 2020. Consecutive cases were identified through neuro-oncology multidisciplinary meetings. Eligible cases included adults with a supratentorial histopathologically confirmed glioblastoma with pre/post-operative reported T1-weighted MRI with contrast deemed suitable for resection. Outcomes included the availability and usage of surgical adjuncts, and the percentage of operations that achieved their aim of complete resection, defined as complete resection of enhancing tumour (CRET) on post-operative T1-MRI. We present the initial descriptive statistics from this national study.
Results
232 patients with glioblastoma were included. In 142 patients (61.2%) the surgical aim was CRET. 5-ALA and neuronavigation were available in all centres (Figure 1). The most commonly used neurosurgical adjunct was neuronavigation (88.2%) (Figure 2). The proportion of patients receiving 5-ALA in CRET and debulking-only groups was 65.0% and 48.9%, respectively. 35 different combinations of adjuncts were found in total, with 13 unique combinations only used in one instance (Figures 1 & 2). CRET was achieved in 69/142 (45.8%) patients in which was the aim. 9/90 (10%) patients in the debulking-only group achieved CRET, of which 7/9 (77.8%) had received 5-ALA. Of the three most frequently used combination of adjuncts for patients deemed feasible for CRET, the most successful in terms of achieving CRET was the combined use of neuronavigation, 5-ALA and IoUS, with post-operative CRET at 47.4% (Figure 3).
Conclusion
ELISAR-GB has collated prospective data to demonstrate the current use of intraoperative adjuncts in the UK and Ireland. There is marked heterogeneity with regards to combinations of adjuncts used. A CRET of 47% is lower than would be expected compared to previously published literature, possibly due to a more stringent definition of complete resection in this study. Based on these early descriptive results, there is no clear combination of adjuncts that shows superiority and use of 5-ALA does not always result in CRET when it is the surgical aim. Of interest, 5-ALA is being used for operations that do not aim for complete resection, a change in indication. The FUTURE GB trial will provide more conclusive evidence on the efficacy of surgical adjuncts to maximise extent of resection.
Abstract
Aims
Objective: Active acromegaly is associated with increased mortality. While surgery is the mainstay of treatment, it is not always curative. In selected cases, CyberKnife stereotactic ...radiosurgery (CK SRS) can be used as adjuvant treatment in patients with persistent disease.
Method
Methodology: Biochemical response was measured using serum IGF-1 levels, calculated as a percentage of the upper limit of normal (% ULN). Levels were recorded prior to treatment, at 6-12 months post-treatment and at the most recent follow-up. Anterior pituitary hormone deficits were assessed before and after treatment. Tumour size was followed-up using MRI.
Results
10 patients (7 male, mean age 36 yrs +/- 12.6, SD) with acromegaly were treated with CK SRS. 9 were treated following failure to attain biochemical remission with TSS. 1 had primary CK SRS. 2 had previous conventional fractionated external beam radiotherapy.
Median tumour diameter was 6 mm (IQR 5.2-10.5 mm), with cavernous sinus invasion in 2 cases. The dose was 20-24Gy/1#. 4 patients were on dopamine agonist, 4 on somatostatin analogue and 2 on pegvisomant. Mean follow-up 31.6 months (+/- 13.5 months, SD).
Median IGF-1 % ULN was 146% pre-treatment (IQR 126.5-208.5), 109% at 6-12 months (IQR 76.5-131%) and 71% (IQR 59-91%) at last follow-up. Mean radiological follow-up 16.6 months (+/- 15.9 months, SD). No cases showed tumour enlargement.
One patient developed secondary hypothyroidism. Side-effects: headache (7 patients), blurred vision (1 patient), fatigue/nausea (1 patient). No new visual fields defects, cranial nerve palsies, cerebrovascular events or secondary tumours.
Conclusion
Conclusions: CK SRS appears safe and effective in selected patients with acromegaly, when there is failure to attain biochemical cure with surgery and in patients intolerant or resistant to medical treatment.
Abstract
Aims
Since 2016, the University Hospital Southampton NHS Foundation Trust (UHSFT) has been commissioned by NHS England to deliver SRST to brain metastases. At UHSFT, all referrals are ...discussed at the Wessex Neurosciences multidisciplinary team meeting. Referrals that satisfy the criteria set by NHS England (estimated prognosis greater than 6 months, absence or controlled extracranial disease or potentially controllable extracranial disease with a Karnofsky Performance Status >70%) will be offered SRST. This retrospective study was performed to assess overall survival rates of patients with brain metastases treated with SRST with further tumour subtype analysis. We also benchmarked our results with other SRST centres.
Method
Retrospective data collection was performed for all the patients who have been treated with SRST. Patients who received SRST to a single metastasis, multiple metastases and/or to the resection cavity between 01/01/2017 to 30/09/2019 were included in this study. All treatment was delivered using a LINAC based SRST platform. Prescription doses ranged from 13.5 Gy to 21 Gy in a single fraction, 21 to 24 Gy in 3 fractions and 25 Gy in 5 fractions. Patients are treated using a stereotactic thermoplastic immobilisation shell and dynamic conformal arc therapy with ExacTrac TM and Cone Beam CT imaging. Dates of death were obtained from the NHS Digital Spine and survival analysis using median overall survival was performed using the Kaplan Meier Method.
Results
277 patients were treated between 01/01/17 and 30/9/2019. The median overall survival from the Kaplan Meier Method was shown to be 14.7 months and the 6-month overall survival was 71% for all patients.
Sub-group analysis of individual tumour sites showed: lung (n=110) median OS 12.1 months, melanoma (n=58) median OS 26.4 months, breast (n=46) median OS not reached (67% still alive) but 18 months survival was 70%, renal (n=22) median OS 15.4 months and colorectal (n=19) median OS 6 months. “Other” tumour sites (n=22) included patients with ovarian, neuroendocrine, sarcoma, testis, oesophagus, unknown primary and gallbladder which were grouped together due to small patient numbers. 41% of patients treated were alive at the time of analysis.
Conclusion
Patients with brain metastases treated with SRST at UHFST have similar outcomes compared to other SRST centres. These patients have a median overall survival of 14.7 months. However, 29% of patients analysed did not survive more than 6 months. Further collection and analysis of the data might improve patient selection and their outcomes.
Abstract
Aims
Molecular profiling is increasingly used in the diagnosis of CNS and non-CNS neoplasms. More than a quarter of all soft tissue tumours are characterized by specific recurrent ...chromosomal translocations which can be used as molecular signatures. With increasing frequency, EWSR1 rearrangements are found on both mesenchymal tumours and primary glial/neuronal tumours.
Here we present a case of intracranial myxoid mesenchymal tumour (IMMT), a rare tumour which is becoming more recognised in recent years, affecting mainly children and young adults, and rarely older adults. It can be found in intraaxial and extraaxial location, with frequent dural connection. The tumour is defined by the genetic hallmark of EWSR1-CREB family gene fusion. Including our case, 16 intracranial tumours with this gene fusion have been reported to date.
Our goal is to contribute further to the characterisation of the morphological spectrum, fusion partners and biological behaviour of rare EWSR1-CREB (non-ETS)-rearranged tumours of the CNS.
Method
Case: The patient is a 27 year old woman with a frontal lobe lesion, radiologically described as a tumour with dural attachment. She underwent surgical debulking, and tumour tissue was histologically examined with conventional immunohistochemistry. Additional genetic testing included targeted mutation screening, FISH, EPIC (Illumina BeadChip) methylation array and next generation sequencing. Histology showed a mitotically active neoplasm with relatively uniform cells, round nuclei and oligodendroglioma-like clear cell change, but no myxoid change. Glomeruloid microvascular proliferation and large areas of tumour necrosis were present. Immunohistochemistry was focally positive for GFAP, and negative or normal for synaptophysin, IDH1 R132H mutation, ATRX and p53. The ki-67 index reached ~20%. Sequencing of IDH1 and IDH2 did not reveal rare IDH mutations, and FISH did not show 1p19q codeletion. Testing for BRAF V600 mutation was negative.
Results
Although the histology initially suggested a diagnosis of oligodendroglioma, the integrated diagnosis was compatible with glioblastoma, IDH wildtype. Methylation array analysis by EPIC array did not result in classification of currently known entities, neither confirming glioblastoma, nor providing a new diagnosis, when analysed on both brain tumour and sarcoma classifier. This suggested a novel tumour entity not yet represented in the classifier algorithm. Additional testing including next generation sequencing revealed EWSR1 gene rearrangement with fusion partner ATF1 (EWSR1-ATF1 fusion). Based on this, the diagnosis was revised to the emerging new entity of ‘intracranial myxoid mesenchymal tumor’ (IMMT) characterised by EWSR1 fusion with members of the cAMP response element binding protein (CREB) family (ATF1, CREB1 and CREM). Subsequent immunohistochemistry demonstrated positive staining for CD99 and EMA but not desmin. The patient underwent various oncological treatments and is recurrence-free 3 years after initial diagnosis.
Conclusion
Histologically, IMMT demonstrates a spectrum of features that overlaps with other tumours, but often displays circumscribed growth, uniform cellularity, cytoplasmic clearing and variable myxoid change. The clinical behaviour of these tumours is not fully understood, however provisionally considered intermediate grade.
EWSR1-CREB family fusion is not specific but shared with a diverse group of extracranial tumours including soft tissue, salivary gland, odontogenic and myoepithelial tumours. Therefore, clinico-radiologico-pathological correlation is essential to achieve the final diagnosis, and ensure the absence of a primary tumour elsewhere.
Familiarisation with IMMT, its characteristic genetic profile and its as yet underreported natural course is crucial, as it can clinically mimic other intracranial tumours such as malignant meningioma or glioma but appears to behave less aggressively than high grade glioma.
It is also important to further our understanding of its optimal treatment through review of larger case series and global comparison of patient management.
Abstract
Aims
The NF2 gene encodes the tumour suppressor Merlin, which is deleted in 100% of patients with the familial tumour predisposition syndrome neurofibromatosis type 2 but also in 70% of ...those who develop sporadic schwannomas. The Raf-TR mouse model uses a tamoxifen-inducible Raf-kinase/ oestrogen receptor fusion protein (Raf-TR) expressed in myelinating Schwann cells to mimic a nerve injury response in Schwann cell by activating Raf/MEK/ERK signalling in the absence of peripheral nerve injury.
We will assess whether Raf/MEK/ERK activation on an NF2 null background leads to tumourigenesis within the vestibular nerves and dorsal root ganglia (DRGs), two tumour sites identified in the Periostin-Cre mouse model in which schwannoma formation is spontaneous, with a view to generating an inducible NF2 null schwannoma mouse model.
Method
Mice with a Schwann cell specific loss of Merlin were crossed with mice carrying a tamoxifen-inducible Raf-TR gene to generate Raf-TR+/-; P0-Cre+/-; NF2fl/fl (Cre+) mice which were NF2 null and compared to Raf-TR+/-; P0-Cre-/-; NF2fl/fl (Cre-) littermate controls. Mice were injected with tamoxifen or vehicle for five consecutive days and their vestibular nerves and dorsal root ganglia (DRGs) were analysed at various timepoints . An EdU proliferation assay was used to quantify the proliferation in the vestibular ganglia, as well as the DRGs. Rates of proliferation were compared to Cre- age-matched littermate controls treated with tamoxifen or vehicle.
Results
In the Periostin-Cre NF2 null schwannoma model, tumours form spontaneously in the DRGs and vestibular ganglia. In our new model, we see a clear increase in proliferation at 21 d post-injection in the NF2 null (Cre+) tamoxifen-treated mice compared to control (Cre-) tamoxifen-treated controls in both DRGs and vestibular ganglia. Cre- tamoxifen-treated mice do not show increased proliferation compared to Cre- vehicle controls. Taken together, this shows that activation of the Raf/MEK/ERK pathway in Schwann cells only causes a sustained proliferation response on an NF2 null background in the DRGs and vestibular ganglia. We are assessing later timepoints to further characterise tumour development in these mice.
Conclusion
Combining the Raf-TR mouse model to create a demyelinating phenotype with an NF2 null background leads to vastly increased rates of proliferation at the sites of schwannoma tumourigenesis within the peripheral nervous system: the DRGs and the vestibular ganglia. The high proliferation in the vestibular ganglia in particular is similar to the development of vestibular schwannomas in patients with Neurofibromatosis type 2. The new mouse model used in this study shows potential to be very useful as an inducible schwannoma tumour model, in which we can study the early events of tumour formation.
Abstract
Aims
The World Health Organisation (WHO) classification of adult gliomas has undergone significant revision in recent years, with current emphasis on the role of the molecular biomarkers ...IDH, 1p19q, ATRX, and p53 for classification of glioblastoma, astrocytoma, and oligodendroglioma. When correctly applied the T2-FLAIR mismatch sign is reported to have 100% specificity for WHO grade II or III IDH mutant 1p19q non-codeleted astrocytoma. We sought to verify this classic imaging-molecular correlate in our cohort at a single tertiary level neurosurgical referral centre in the United Kingdom.
Method
Data were gathered by searching the histopathology database for cases between 2014 and 2019 containing the keywords ‘IDH Mutant’ AND ‘Astrocytoma’ or ‘Glioblastoma’ or ‘Oligodendroglioma’ in the report. Inclusion criteria: Biopsy/resection proven IDH mutant tumours in adults (age >17). A strict application of the T2-FLAIR mismatch sign was used when evaluating MRI. Native T2 signal was required to be homogenous or near homogenous, with hypointense signal on T2 weighted FLAIR except for a hyperintense peripheral rim. In addition, the T2-FLAIR mismatch sign was not applied to tumours showing any unequivocal contrast enhancement or macrocystic change.
Results
66/185 cases were excluded for reasons of insufficient imaging, duplication, 1p19q partial deletion/unknown + ATRX wild type/unknown, IDH wild type/negative, Grade IV histology. 119 cases fit the inclusion criteria, all IDH positive. Group 1 comprised 49 (39%) 1p19q codeleted tumours, or oligodendrogliomas. ATRX was wild type (78%), unknown (18%), or mutated (<1%). Group 2 comprised 37 (29%) 1p19q non-codeleted tumours, or astrocytomas. ATRX was mutated (70%), unknown (22%), wild type (5%), or equivocal (3%). Group 3 comprised 41 (32%) 1p19q unknown tumours, all ATRX mutated, p53 expressed (83%). When p53 status was unaltered/equivocal, microscopy was convincingly astrocytic. Groups 2 and 3 comprised the astrocytomas (61%). T2-FLAIR mismatch was positive in 5 1p19q non-codeleted astrocytomas, 5 1p19q unknown ATRX mutant astrocytomas, and no 1p19q co-deleted oligodendrogliomas. Test sensitivity and specificity was 14% and 100% for 1p19q non-codeletion, 13% and 100% for ATRX mutation.
Conclusion
Although relatively uncommon, when present and correctly applied we confirm 100% specificity of the T2-FLAIR mismatch sign for IDH mutant 1p19q non-codeleted astrocytoma. However, if 1p19q status is unknown, clear astrocytic histology and ATRX mutation and/or p53 overexpression is also considered sufficient to diagnose astrocytoma. When 1p19q status is unavailable we also report 100% specificity of T2-FLAIR mismatch for ATRX mutated astrocytomas. T2-FLAIR mismatch was not observed in any 1p19q codeleted oligodendrogliomas or ATRX wild type tumours. More accurate methods of non-invasive glioma diagnosis will help improve neurohistopathological correlation, prognostication, and guide the tempo of the pre-operative planning phase.
Abstract
Aims
Glioblastoma Multiforme (GBM) is one of the most aggressive primary brain tumors with poor prognosis (median survival 18 months) and no cure. Management strategies often involve maximum ...safe resection followed by chemoradiotherapy. There has been a move from managing such patients electively rather than the traditional model of treating them as an emergency. While this may have advantages, this can delay the time from presentation to operation. This delay has recently been further compounded by the current COVID-19 pandemic.
There is no data available as to whether the surgical delays that are currently occurring have an impact on patient care, and may outweigh the benefits of elective management on health services.
We aimed to conduct a single centre observational study to assess how long patients should be waiting prior to surgery. We hypothesised that the longer the wait, the higher the pre-operative complication rate and worse the outcomes.
Method
698 patients in a GBM database over a 5-year period (29/10/14- 8/11/19) were studied. All patient data was accessed via electronic patient records
Surgical delay was defined as the interval between date of being put on the waiting list (the date seen in the neuro-oncology clinic) to date of surgery.
Primary outcome measure was preoperative complications, which was categorised into transient neurological decline, stroke, seizures, diabetes/erratic blood sugars, emergency admission, others (e.g., cardiovascular compromise, steroid complications, blood disorders)
Inclusion criteria included: First presentation supratentorial WHO Grade 4 GBM confirmed on histology (this included histological variants such as Gliosarcoma and Epithelioid Glioblastoma), and all patients who had been seen in the neuro-oncology clinic prior to surgery.
Exclusion criteria included all patients who were not thought to have a GBM or high-grade glioma on initial imaging, those admitted as an emergency without being seen in a neuro-oncology clinic, recurrent or secondary GBMs.
Results
460 patients met the inclusion criteria in this study. There was a pre-operative complication rate of 14.6% (67/460). 55% of complications were due to a transient neurological decline (37/67) with 16.4 % (11/67) of patients presenting with seizures. For those with surgical delays ≤7 days pre-operative complication rates were 2.2 % vs 15.9% in those with delays >7 days, p value 0.012, Odds ratio 8.53 (95% CI 1.48- 88.09). Results were statistically significant in those with delays greater than 10 and 14 days (p values 0.0026 and 0.0004 respectively)
ROC Curve analysis revealed an AUC of 0.66 with sensitivities of 99%, 90% and 76% at surgical delays of 7,10 and 14 days respectively.
The median length of hospital admission in both groups of patients was 5 days (p= 0.2065)
All statistical analysis was carried out using Prism 9 and SPSS
Conclusion
In spite of unchanged length of hospital stay, we note a significant increase in pre-operative complication rates as a result of surgical delays greater than 7,10 and 14 days, which introduces an interesting debate in the merit of delaying operations for further assessment in clinic. Our objectives would be to minimize complication rate, therefore a high sensitivity i.e. true positive rate would be most desirable. The 99% levels achieved at 7 days In the ROC analysis lends weight to introducing policy to fast-track admissions for primary GBM patients.
Further directions could include assessing the impact reduced surgical services and redeployment might have had on complications rates and length of hospital stay on patients admitted over the COVID 19 pandemic.
Abstract
Aims
Morbidity and mortality following resection of malignant primary brain tumours is high. The benefits of reoperation for recurrent tumours are uncertain and it is not known how ...frequently patients in England undergo further tumour resections. The aim of this study was to describe 30-day and one-year readmission rates, the clinical reasons for readmission and the rate of resections for recurrent tumours.
Method
Patient data was extracted from Hospital Episode Statistics (the hospital administrative data for NHS hospitals in England) for all supratentorial, malignant, primary brain tumour resections performed from April 2013 to March 2017. All subsequent non-elective readmissions to any NHS hospital and all readmissions for further tumour resection within 30 days and one year were analysed for the primary clinical diagnosis and primary procedure performed.
Results
A total of 6,982 patients were identified and the 30-day and one-year readmission rates were 18.6% (n=1,298) and 57.4% (n=4,007), respectively. The rates of reoperation for tumour resection were 0.5% (n=33) and 6.2% (n=432), respectively. The commonest reasons for 30-day readmission were post-operative complications (17.9% of admissions), general medical complications (17.3%) and surgical site infection (9.6%). The most frequently performed neurosurgical procedures were for treatment of surgical site infection (37.6% of procedures). The commonest reasons for readmission within one year were general medical complications (17.4%), seizures (14%), systemic infections (11.4%) and post-operative complications (11%). Almost half of all neurosurgical procedures performed within one year were reoperation for tumour resection (45.6%), while treatment of surgical site infection (17.9%) and CSF shunt insertions and revisions (9.1%) were also common.
Conclusion
This study provides a descriptive analysis of the rates of readmission, diagnosis on readmission, and the need for further neurosurgical procedures. The rate of non-elective readmissions within one year is high and these data may be useful for service planning and for counselling patients about their treatment. Additionally, these data contribute to the development of quality indicators, for benchmarking and comparing quality of care provision between neurosurgical units. Further research, with linkage to histology data and performance status, would support an analysis of the role of resection of recurrent, malignant, primary brain tumours.
Abstract
Aims
During the first wave of the COVID-19 pandemic, to limit the number of patients attending hospital, the neuro-oncology department selected a large number of appointments to be conducted ...via the telephone.
This project aimed to determine how patients and clinicians perceived telephone consultations in the neuro-oncology service compared to traditional face to face appointments.
Method
A 20-question patient satisfaction survey combined quantitative and qualitative questions and was distributed between June and August 2020. These were distributed by email to 88 patients who attended neuro-oncology clinic in person ("face-to-face"), or by telephone.
Concurrently, a 15-question survey was distributed to all clinicians conducting telephone and face-to-face consultations for the neuro-oncology service. Questions included in the clinician survey were designed to mirror the patient satisfaction questionnaire where possible.
Fisher's exact test was used to determine significance, which was set at p< 0.05.
Results
51.1% (n=45) of patients returned the questionnaire.
Of those who received telephone appointments, 89.5% (n=17) felt the consultation was convenient, 94.7% (n=18) were satisfied and 80.0% (n=16) were able to have a family member/friend present.
Of those who attended face-to-face appointments, 96.0% (n=24) felt their consultation was convenient, 100% (n=25) were satisfied and 87.5% (n=21) were able to have a family member/friend present.
There was no significant difference in patient convenience, satisfaction or family/friend presence (p=0.395, p=0.432 and p=0.498 respectively) between face-to-face and telephone clinics.
Overall, the clinicians reported undertaking a mean of 9.5 telephone consultations per week. Only 42.8% (n=3) use telephone appointments for first-time neuro-oncology consultations, whereas 100.0% (n=7) use them for results and follow-up appointments. Only 51.7% (n=4) felt that undertaking telephone consultations is convenient and 42.8% (n=3) have experienced difficult situations with patients during telephone consultation.
Conclusion
This project suggests that neuro-oncology telephone consultations provide patients with the same level of satisfaction and convenience as face-to-face appointments. We have also demonstrated that using the telephone does not provide a significant barrier to having family or friends present to support the patient.
We have shown that clinicians are universally utilising neuro-oncology telephone appointments for follow-up and results whereas much fewer use the telephone for performing initial consultations. Given the high-level of satisfaction demonstrated in the patient questionnaires this reflects effective patient-selection for remote consultations.
The COVID-19 pandemic has forced oncology services to evolve and results of this project suggest that telephone neuro-oncology consultations are widely accepted by patients and clinicians. We therefore propose that remote consultations should continue beyond the pandemic in select cases.
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