Patterns of care for adults with newly diagnosed malignant glioma.
BACKGROUND
Patients with malignant glioma (grade III or IV) face a poor prognosis, and few evidence-based treatment guidelines are available. There is a dearth of prospective data on patterns of care for these patients.


OBJECTIVE
To provide benchmark data to enable comparison of individual practice patterns and outcomes.


METHODS
The Glioma Outcomes (GO) Project enrolled 788 patients at 52 clinical sites, both academic and community practices, between December 1997 and July 2000. The enrollment criteria included adult patients with primary grade III or IV glioma undergoing a first or second operation for diagnosis or treatment. The data collection instruments included questionnaire forms given at enrollment, during the perioperative period, and at follow-up intervals of 3 months until death or a maximum of 24 months. Of the patients recorded in the GO database, 565 patients with newly diagnosed tumors were used for this analysis.


METHODS
Patterns of care (surgical management, perioperative care, postoperative management).


RESULTS
Most patients underwent magnetic resonance imaging (n = 518; 92%) and an attempt at tumor resection (n = 425; 75%). Cortical mapping (n = 107; 19%) and intraoperative image guidance (n = 161; 29%) were uncommon. Most received perioperative corticosteroids (n = 535; 99%) and antiepileptic medications (n = 497; 88%), but few received antidepressants (n = 38; 8%) or prophylactic heparin (n = 42; 7%). Most received adjuvant radiation therapy (n = 479; 87%), but fewer received chemotherapy (n = 300; 54%). Practice patterns varied significantly between academic and community settings.


CONCLUSIONS
Reliance on magnetic resonance imaging, surgery, and radiation is generally accepted; however, relatively infrequent chemotherapy use may conflict with published literature, and frequent use of prophylactic antiepileptic medications contradicts established practice guidelines. Other practice patterns involving surgical adjuncts, prophylactic heparin, and antidepressants require further investigation to clarify appropriateness. Establishing further clinical guidelines may help reduce variability in practice patterns.
Chang
Susan M
SM
Department of Neurological Surgery, University of California, San Francisco, CA 94143-0350, USA. changs@neurosurg.ucsf.edu
Parney
Ian F
IF
Huang
Wei
W
Anderson
Frederick A
FA
Asher
Anthony L
AL
Bernstein
Mark
M
Lillehei
Kevin O
KO
Brem
Henry
H
Berger
Mitchel S
MS
Laws
Edward R
ER
D000328:Adult; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014481:United States