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Article

Optimising Outcomes for Glioblastoma through Subspecialisation in a Regional Cancer Centre

1
Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
2
Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW 2250, Australia
3
Genesis Cancer Care, Sydney, NSW 2015, Australia
4
Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
5
The Brain Cancer Group, Sydney, NSW 2065, Australia
6
Sydney Brain Tumour Clinic, Sydney, NSW 2065, Australia
*
Author to whom correspondence should be addressed.
Brain Sci. 2018, 8(10), 186; https://doi.org/10.3390/brainsci8100186
Received: 18 September 2018 / Revised: 5 October 2018 / Accepted: 9 October 2018 / Published: 15 October 2018
(This article belongs to the Special Issue Optimizing Management of High Grade Glioma)
Delivery of highly sophisticated, and subspecialised, management protocols for glioblastoma in low volume rural and regional areas creates potential issues for equivalent quality of care. This study aims to demonstrate the impact on clinical quality indicators through the development of a novel model of care delivering an outsourced subspecialised neuro-oncology service in a regional centre compared with the large volume metropolitan centre. Three hundred and fifty-two patients with glioblastoma were managed under the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) Protocol, and survival outcome was assessed in relation to potential prognostic factors and the geographical site of treatment, before and after opening of a regional cancer centre. The median overall survival was 17 months (95% CI: 15.5–18.5), with more favourable outcome with age less than 50 years (p < 0.001), near-total resection (p < 0.001), Eastern Cooperative Oncology Group (ECOG) Performance status 0, 1 (p < 0.001), and presence of O-6 methylguanine DNA methyltransferase (MGMT) methylation (p = 0.001). There was no difference in survival outcome for patients managed at the regional centre, compared with metropolitan centre (p = 0.35). Similarly, no difference was seen with clinical quality process indicators of clinical trial involvement, rates of repeat craniotomy, use of bevacizumab and re-irradiation. This model of neuro-oncology subspecialisation allowed equivalent outcomes to be achieved within a regional cancer centre compared to large volume metropolitan centre. View Full-Text
Keywords: glioblastoma; sub specialization; provider volume glioblastoma; sub specialization; provider volume
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MDPI and ACS Style

Back, M.; Jayamanne, D.; Cove, N.; Wheeler, H.; Khasraw, M.; Guo, L.; Back, J.; Wong, M. Optimising Outcomes for Glioblastoma through Subspecialisation in a Regional Cancer Centre. Brain Sci. 2018, 8, 186. https://doi.org/10.3390/brainsci8100186

AMA Style

Back M, Jayamanne D, Cove N, Wheeler H, Khasraw M, Guo L, Back J, Wong M. Optimising Outcomes for Glioblastoma through Subspecialisation in a Regional Cancer Centre. Brain Sciences. 2018; 8(10):186. https://doi.org/10.3390/brainsci8100186

Chicago/Turabian Style

Back, Michael, Dasantha Jayamanne, Nicola Cove, Helen Wheeler, Mustafa Khasraw, Linxin Guo, Jemimah Back, and Matthew Wong. 2018. "Optimising Outcomes for Glioblastoma through Subspecialisation in a Regional Cancer Centre" Brain Sciences 8, no. 10: 186. https://doi.org/10.3390/brainsci8100186

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