title: Implementation of neuro-oncology service reconfiguration in accordance with NICE guidance provides enhanced clinical care for patients with glioblastoma multiforme.
abstract: BACKGROUND
  Brain tumours account for <2% of all primary neoplasms but are responsible for 7% of the years of life lost from cancer before age 70 years. The latest survival trends for patients with CNS malignancies have remained largely static. The objective of this study was to evaluate the change in practice as a result of implementing the Improving Outcomes Guidance from the UK National Institute for Health and Clinical Excellence (NICE).
  
  
  METHODS
  Patients were identified from the local cancer registry and hospital databases. We compared time from diagnosis to treatment, proportion of patients discussed at multidisciplinary team (MDT) meetings, treatment received, length of inpatient stay and survival. Inpatient and imaging costs were also estimated.
  
  
  RESULTS
  Service reconfiguration and implementation of NICE guidance resulted in significantly more patients being discussed by the MDT--increased from 66 to 87%, reduced emergency admission in favour of elective surgery, reduced median hospital stay from 8 to 4.5 days, increased use of post-operative MRI from 17 to 91% facilitating early discharge and treatment planning, and reduced cost of inpatient stay from £2096 in 2006 to £1316 in 2009. Patients treated with optimal surgery followed by radiotherapy with concomitant and adjuvant temozolomide achieved outcomes comparable to those reported in clinical trials: median overall survival 18 months (2-year survival 35%).
  
  
  CONCLUSIONS
  Advancing the management of neuro-oncology patients by moving from an emergency-based system of patient referral and management to a more planned elective outpatient-based pattern of care improves patient experience and has the potential to deliver better outcomes and research opportunities.
authors: Cambridge University Department of Clinical Neurosciences, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
authors: M R
authors: MR
authors: Guilfoyle
authors: R A
authors: RA
authors: Weerakkody
authors: A
authors: A
authors: Oswal
authors: I
authors: I
authors: Oberg
authors: C
authors: C
authors: Jeffery
authors: K
authors: K
authors: Haynes
authors: P J
authors: PJ
authors: Kullar
authors: D
authors: D
authors: Greenberg
authors: S J
authors: SJ
authors: Jefferies
authors: F
authors: F
authors: Harris
authors: S J
authors: SJ
authors: Price
authors: S
authors: S
authors: Thomson
authors: C
authors: C
authors: Watts
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