Health Service Focus

27.11.19

Treating the patient as a whole - not just the cancer

Source: NHE Nov/Dec 19 

Puneet Plaha, consultant neuro-oncology surgeon at GenesisCare, as well as chair of the tumour section of the Society of British Neurological Surgeons.

The incidence of brain metastasis – cancer that has spread to the brain from another part of the body – is increasing. The key reasons are; the better - and early - use of brain MRI (magnetic resonance imaging) and improved systemic treatment of the extracranial primary cancer, meaning patients will survive long enough for the cancer to spread to the brain.

Conventional radiotherapy treatments for a brain metastasis involves whole brain radiotherapy (WBRT), however, this often leads to cognitive deterioration, with limited benefit in terms of overall survival. Up to 30 percent of cancer patients are likely to develop a brain metastasis. The challenge, therefore, for treatment providers is to design a service that balances the need to treat the cancer versus the desire to improve patient quality of life. A holistic, whole patient centric approach to treatment is required.

Stereotactic radiosurgery (SRS) is an innovation - often described as non-invasive brain-sparing surgery – that has transformed the treatment of brain metastases in the last decade. It delivers precisely-focused radiation beams in a single (SRS) treatment or a few short treatments (known as stereotactic radiotherapy, or SRT). This highly advanced approach permits the maximum conformal dose to ensure ablation (destruction) of tumour cells while minimising the dose to the surrounding unaffected brain. The aim is to destroy the tumour and achieve permanent local control, whilst preserving important brain function.

Initially, SRS was used in combination with WBRT, but recently the role of SRS on its own in the management of brain metastasis has been widely researched. The results are promising. Although WBRT with SRS does result in less frequent intracranial metastasis progression than SRS alone, numerous studies have failed to show any significant difference in overall survival rates between the two approaches. However, the evidence is clear that SRS alone benefits in significantly less decline in cognitive deterioration, along with better quality of life (QoL).

The overriding question then is whether metastasis progression in the brain is more detrimental to a patient’s wellbeing than the potential deterioration of cognitive function and quality of life associated with WBRT. This has directed a move away from WBRT and SRS is now replacing conventional WBRT as procedure of choice for solitary and/or multiple brain metastasis and also some other primary brain tumours which respond to SRS.

However, SRS is not appropriate for every cancer type - small-cell lung metastasis is one example where WBRT remains the gold standard radiotherapy treatment. For this reason, there has also been considerable research and innovation focusing on eloquent brain-area sparing techniques that play a role in preserving quality of life, often used alongside surgery.

Whatever the treatment pathway, there is invariably a need for active surveillance and imaging such as MRI. NICE guidance on treatment of brain metastasis acknowledges that whilst frequent hospital visits for scanning appointments is reassuring to some, it may cause anxiety for others. Add to this the natural distress and uncertainty of living with the disease. A neuro-oncological service needs to fully embrace the wider role of the multi-disciplinary team to streamline care plans and provide support and intervention where possible, including wellbeing services, to enable patients and families to retain control over decisions and get the best possible life outcome.

At GenesisCare we have a well set-up multidisciplinary team of oncologists, neurosurgeons, neuro radiologists and advanced brain imaging experts. They review every case and plan a treatment pathway in consultation with the patient as part of a shared decision-making approach. It recognises that every patient is unique and treatments need to be tailored to individual needs.

In summary, brain metastasis account for the majority of intracranial malignancies. As disease progresses there will often be some cognitive deterioration, but the challenge is to slow the disease without accelerating deterioration – preserving quality of life for as long as possible. SRS currently offers an optimum solution for many patients if used as part of a wider approach that treats the whole patient, not just their cancer.

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Kindness is key to overcoming Covid-19 crisis

26/05/2020Kindness is key to overcoming Covid-19 crisis

Nuno Albuquerque, Group Treatment Lead, UK Addiction Treatment Group, explains why your mental health is just as important as washing your hands ... more >
UK study to examine Covid-19 impact on blood cancer patients

26/05/2020UK study to examine Covid-19 impact on blood cancer patients

A new UK study is being launched by IMPACT to examine how patients receiving stem cell transplants for blood cancers and blood disorders react to... more >
Pre-diabetes: a hidden healthcare problem

26/05/2020Pre-diabetes: a hidden healthcare problem

Dr Russell Muirhead, Clinical Director of Living Well, Taking Control A third of adults in England have pre-diabetes, according to research pu... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

the scalpel's daily blog

Pre-diabetes: a hidden healthcare problem

26/05/2020Pre-diabetes: a hidden healthcare problem

Dr Russell Muirhead, Clinical Director of Living Well, Taking Control A third of adults in England have pre-diabetes, according to research published in The BMJ. The study also found that, over eight years, the number of people diagnosed with pre-diabetes tripled. By 2025, it is estimated that five million people will have diabetes in the UK – 90% of which is Type 2 diabetes. Pre-diabetes is related to increasing rates of obesi... more >
read more blog posts from 'the scalpel' >

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

interviews

Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >