nach oben

25.04.2024 | Research

Exploring the impact of primary care utilization and health information exchange upon treatment patterns and clinical outcomes of glioblastoma patients

verfasst von: Megan Parker, Foad Kazemi, A. Karim Ahmed, Cathleen C. Kuo, Sumil K. Nair, Jordina Rincon-Torroella, Christopher Jackson, Gary Gallia, Chetan Bettegowda, Jon Weingart, Henry Brem, Debraj Mukherjee

Erschienen in: Journal of Neuro-Oncology

Einloggen, um Zugang zu erhalten

Abstract

Purpose

There is limited literature describing care coordination for patients with glioblastoma (GBM). We aimed to investigate the impact of primary care and electronic health information exchange (HIE) between neurosurgeons, oncologists, and primary care providers (PCP) on GBM treatment patterns, postoperative outcomes, and survival.

Methods

We identified adult GBM patients undergoing primary resection at our institution (2007–2020). HIE was defined as shared electronic medical information between PCPs, oncologists, and neurosurgeons. Multivariate logistic regression analyses were used to determine the effect of PCPs and HIE upon initiation and completion of adjuvant therapy. Kaplan-Meier and multivariate Cox regression models were used to evaluate overall survival (OS).

Results

Among 374 patients (mean age ± SD: 57.7 ± 13.5, 39.0% female), 81.0% had a PCP and 62.4% had electronic HIE. In multivariate analyses, having a PCP was associated with initiation (OR: 7.9, P < 0.001) and completion (OR: 4.4, P < 0.001) of 6 weeks of concomitant chemoradiation, as well as initiation (OR: 4.0, P < 0.001) and completion (OR: 3.0, P = 0.007) of 6 cycles of maintenance temozolomide thereafter. Having a PCP (median OS [95%CI]: 14.6[13.1–16.1] vs. 10.8[8.2–13.3] months, P = 0.005) and HIE (15.40[12.82–17.98] vs. 13.80[12.51–15.09] months, P = 0.029) were associated with improved OS relative to counterparts in Kaplan-Meier analysis and in multivariate Cox regression analysis (hazard ratio [HR] = 0.7, [95% CI] 0.5-1.0, P = 0.048). In multivariate analyses, chemoradiation (HR = 0.34, [95% CI] 0.2–0.7, P = 0.002) and maintenance temozolomide (HR = 0.5, 95%CI 0.3–0.8, P = 0.002) were associated with improved OS relative to counterparts.

Conclusion

Effective care coordination between neurosurgeons, oncologists, and PCPs may offer a modifiable avenue to improve GBM outcomes.

Ostrom QT, Price M, Neff C et al (2022) CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015–2019. Neuro-oncology (Charlottesville, Va).;24(Supplement_5):v1-v95. https://doi.org/10.1093/neuonc/noac202

Lamborn KR, Chang SM, Prados MD (2004) Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 6(3):227–235. https://doi.org/10.1215/S1152851703000620CrossRefPubMedPubMedCentral

Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996. https://doi.org/10.1056/NEJMoa043330CrossRefPubMed

Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS (2018) Adult glioma incidence and survival by race or ethnicity in the United States from 2000 to 2014. JAMA Oncol 4(9):1254–1262. https://doi.org/10.1001/jamaoncol.2018.1789CrossRefPubMedPubMedCentral

Lawrie TA, Gillespie D, Dowswell T et al (2019) Long-term neurocognitive and other side effects of radiotherapy, with or without chemotherapy, for glioma. Cochrane Database Syst Rev 8(8):CD013047. https://doi.org/10.1002/14651858.CD013047.pub2CrossRefPubMed

Jimenez AE, Cicalese KV, Chakravarti S et al (2022) Social determinants of health and the prediction of 90-day mortality among brain tumor patients. J Neurosurg Published Online March 11:1–9. https://doi.org/10.3171/2022.1.JNS212829CrossRef

Rhome R, Fisher R, Hormigo A, Parikh RR (2016) Disparities in receipt of modern concurrent chemoradiotherapy in glioblastoma. J Neurooncol 128(2):241–250. https://doi.org/10.1007/s11060-016-2101-5CrossRefPubMed

Aneja S, Khullar D, Yu JB (2013) The influence of regional health system characteristics on the surgical management and receipt of post operative radiation therapy for glioblastoma multiforme. J Neurooncol 112(3):393–401. https://doi.org/10.1007/s11060-013-1068-8CrossRefPubMedPubMedCentral

Huang B, Dolecek TA, Chen Q, Garcia CR, Pittman T, Villano JL (2018) Characteristics and survival outcomes associated with the lack of radiation in the treatment of glioblastoma. Med Oncol 35(5):74. https://doi.org/10.1007/s12032-018-1134-3CrossRefPubMed

10.

Winden TJ, Boland LL, Frey NG, Satterlee PA, Hokanson JS (2014) Care everywhere, a point-to-point HIE tool: utilization and impact on patient care in the ED. Appl Clin Inf 5(2):388–401. https://doi.org/10.4338/ACI-2013-12-RA-0100CrossRef

11.

Lee SJC, Clark MA, Cox JV, Needles BM, Seigel C, Balasubramanian BA (2016) Achieving coordinated care for patients with complex cases of Cancer: a Multiteam System Approach. J Oncol Pract 12(11):1029–1038. https://doi.org/10.1200/JOP.2016.013664CrossRefPubMedPubMedCentral

12.

Akhlaq A, Sheikh A, Pagliari C (2017) Defining Health Information Exchange: scoping review of published definitions. J Innov Health Inf 23(4):838. https://doi.org/10.14236/jhi.v23i4.838CrossRef

13.

Sadoughi F, Nasiri S, Ahmadi H (2018) The impact of health information exchange on healthcare quality and cost-effectiveness: a systematic literature review. Comput Methods Programs Biomed 161:209–232. https://doi.org/10.1016/j.cmpb.2018.04.023CrossRefPubMed

14.

Louis DN, Perry A, Wesseling P et al (2021) The 2021 WHO classification of tumors of the Central Nervous System: a summary. Neuro-oncology (Charlottesville Va) 23(8):1231–1251. https://doi.org/10.1093/neuonc/noab106CrossRef

15.

von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147(8):573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010CrossRef

16.

Ruley M, Walker V, Studeny J, Coustasse A (2018) The Nationwide Health Information Network: the case of the Expansion of Health Information Exchanges in the United States. Health Care Manag (Frederick) 37(4):333–338. https://doi.org/10.1097/HCM.0000000000000231CrossRefPubMed

17.

Subramaniam S, Aalberg JJ, Soriano RP, Divino CM (2018) New 5-Factor modified Frailty Index using American College of Surgeons NSQIP Data. J Am Coll Surg 226(2):173–181e8. https://doi.org/10.1016/j.jamcollsurg.2017.11.005CrossRefPubMed

18.

Nuño M, Carico C, Mukherjee D et al (2015) Association between in-hospital adverse events and mortality for patients with brain tumors. J Neurosurg 123(5):1247–1255. https://doi.org/10.3171/2014.10.JNS141516CrossRefPubMed

19.

Rakovec M, Camp S, Day D et al (2023) Use of tubular retractors to access deep brain lesions: a case series. J Clin Neurosci 114:64–69. https://doi.org/10.1016/j.jocn.2023.06.002CrossRefPubMed

20.

Brandel MG, Rennert RC, Wali AR et al (2018) Impact of preoperative endovascular embolization on immediate meningioma resection outcomes. Neurosurg Focus 44(4):E6. https://doi.org/10.3171/2018.1.FOCUS17751CrossRefPubMed

21.

Hohmann NS, McDaniel CC, Mason SW et al (2020) Patient perspectives on primary care and oncology care coordination in the context of multiple chronic conditions: a systematic review. Res Social Adm Pharm 16(8):1003–1016. https://doi.org/10.1016/j.sapharm.2019.11.014CrossRefPubMed

22.

Shergalis A, Bankhead A, Luesakul U, Muangsin N, Neamati N (2018) Current challenges and opportunities in Treating Glioblastoma. Pharmacol Rev 70(3):412–445. https://doi.org/10.1124/pr.117.014944CrossRefPubMedPubMedCentral

23.

Kurniasih DAA, Setiawati EP, Pradipta IS, Subarnas A (2022) Interprofessional collaboration in the breast cancer unit: how do healthcare workers see it? BMC Womens Health 22(1):227. https://doi.org/10.1186/s12905-022-01818-7CrossRefPubMedPubMedCentral

24.

Easley J, Miedema B, Carroll JC et al (2016) Coordination of cancer care between family physicians and cancer specialists: importance of communication. Can Fam Physician 62(10):e608–e615PubMedPubMedCentral

25.

Chandra A, Rick JW, Dalle Ore C et al (2018) Disparities in health care determine prognosis in newly diagnosed glioblastoma. Neurosurg Focus 44(6):E16. https://doi.org/10.3171/2018.3.FOCUS1852CrossRefPubMedPubMedCentral

26.

Walter FM, Penfold C, Joannides A et al (2019) Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences. Br J Gen Pract 69(681):e224–e235. https://doi.org/10.3399/bjgp19X701861CrossRefPubMedPubMedCentral

27.

Vidal Lopez C, Ríos Quito GL, Salom Garrigues C, Pellicer Sanahuja AI (2020) [Adverse effects of oncohaematological immunotherapy: implications for primary care and continuity of care]. Semergen 46(1):60–67. https://doi.org/10.1016/j.semerg.2019.07.005CrossRefPubMed

28.

Penfold C, Joannides AJ, Bell J, Walter FM (2017) Diagnosing adult primary brain tumours: can we do better? Br J Gen Pract 67(659):278–279. https://doi.org/10.3399/bjgp17X691277CrossRefPubMedPubMedCentral

29.

Walker D, Hamilton W, Walter FM, Watts C (2013) Strategies to accelerate diagnosis of primary brain tumors at the primary-secondary care interface in children and adults. CNS Oncol 2(5):447–462. https://doi.org/10.2217/cns.13.36CrossRefPubMedPubMedCentral

30.

Qiao EM, Guram K, Kotha NV et al (2022) Association between Primary Care Use Prior to Cancer diagnosis and subsequent Cancer mortality in the Veterans Affairs Health System. JAMA Netw Open 5(11):e2242048. https://doi.org/10.1001/jamanetworkopen.2022.42048CrossRefPubMedPubMedCentral

31.

Sisler JJ, Brown JB, Stewart M (2004) Family physicians’ roles in cancer care. Survey of patients on a provincial cancer registry. Can Fam Physician 50:889–896PubMedPubMedCentral

32.

Dossett LA, Hudson JN, Morris AM et al (2017) The primary care provider (PCP)-cancer specialist relationship: a systematic review and mixed-methods meta-synthesis. CA Cancer J Clin 67(2):156–169. https://doi.org/10.3322/caac.21385CrossRefPubMed

33.

Lee SJC, Jetelina KK, Marks E et al (2018) Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol. BMC Cancer 18(1):1204. https://doi.org/10.1186/s12885-018-5118-7CrossRefPubMedPubMedCentral

34.

Sada YH, Street RL, Singh H, Shada RE, Naik AD (2011) Primary care and communication in shared cancer care: a qualitative study. Am J Manag Care 17(4):259–265PubMedPubMedCentral

35.

Akhlaq A, Sheikh A, Pagliari C (2015) Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review protocol. J Innov Health Inf 22(2):284–292. https://doi.org/10.14236/jhi.v22i2.98CrossRef

Titel: Exploring the impact of primary care utilization and health information exchange upon treatment patterns and clinical outcomes of glioblastoma patients
verfasst von: Megan Parker
Foad Kazemi
A. Karim Ahmed
Cathleen C. Kuo
Sumil K. Nair
Jordina Rincon-Torroella
Christopher Jackson
Gary Gallia
Chetan Bettegowda
Jon Weingart
Henry Brem
Debraj Mukherjee
Publikationsdatum: 25.04.2024
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-024-04677-4

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

29.05.2024 Hyponatriämie Nachrichten

Eine ältere Frau trinkt regelmäßig Sennesblättertee gegen ihre Verstopfung. Der scheint plötzlich gut zu wirken. Auf Durchfall und Erbrechen folgt allerdings eine Hyponatriämie. Nach deren Korrektur kommt es plötzlich zu progredienten Kognitions- und Verhaltensstörungen.

Schutz der Synapsen bei Alzheimer

29.05.2024 Morbus Alzheimer Nachrichten

Mit einem Neurotrophin-Rezeptor-Modulator lässt sich möglicherweise eine bestehende Alzheimerdemenz etwas abschwächen: Erste Phase-2-Daten deuten auf einen verbesserten Synapsenschutz.

Sozialer Aufstieg verringert Demenzgefahr

24.05.2024 Demenz Nachrichten

Ein hohes soziales Niveau ist mit die beste Versicherung gegen eine Demenz. Noch geringer ist das Demenzrisiko für Menschen, die sozial aufsteigen: Sie gewinnen fast zwei demenzfreie Lebensjahre. Umgekehrt steigt die Demenzgefahr beim sozialen Abstieg.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen