title: NICE guidance on the use of carmustine wafers in high grade gliomas: a national study on variation in practice.
abstract: BACKGROUND
  Multidisciplinary team (MDT) working in oncology aims to improve outcomes for patients with cancer. One role is to ensure the implementation of best practice and National Institute for Health and Clinical Excellence (NICE) guidance. In this study, we have assessed the role of MDT in implementing the TA121 appraisal of the use of carmustine wafers in high grade gliomas.
  
  
  METHODS
  296 patients with high-grade glioma suitable for maximal resection were recruited from 17 Neurosurgical Centres. The number of patients treated with carmustine wafers and reasons for not using this were recorded. Complications at 48 hours post-operatively and at 6 weeks post-radiotherapy were recorded.
  
  
  RESULTS
  94/296 (32%) of suitable patients received carmustine wafers. In 55% of cases carmustine was not used due to either surgeon preference or a lack of an MDT decision. There was no increased complication rate with carmustine use at either 48 hours post-surgery or at 6 weeks post radiotherapy. Use of carmustine wafers did not decrease access to and use of chemoradiotherapy.
  
  
  CONCLUSIONS
  One third of patients suitable for carmustine wafers received them. Their use was neither associated with more frequent complications, nor decreased use of chemoradiotherapy. Implementation of NICE TA121 Guidance is extremely variable in different MDTs across the United Kingdom.
authors.affiliation: Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. sjp@cam.ac.uk
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Price
authors.forename: Ian R
authors.initials: IR
authors.lastname: Whittle
authors.forename: Keyoumars
authors.initials: K
authors.lastname: Ashkan
authors.forename: Paul
authors.initials: P
authors.lastname: Grundy
authors.forename: Garth
authors.initials: G
authors.lastname: Cruickshank
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D002330:Carmustine / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D011183:Postoperative Complications / Q000209:etiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine