"We have a long way to go because we still do not have a reliable way of controlling these malignant tumors," said study co-author Dr. Edward R. Laws, Jr., professor of neurological surgery, internal medicine and pediatrics at the University of Virginia Health System. "Physicians and other caregivers do fairly well treating these tumors, but this important study helps us see where we might do better." The average life expectancy for patients with malignant brain tumors is a little over one year, unchanged since the 1960's, Laws said.
The study found that there are common practice patterns that follow published medical findings, such as the use of radiation therapy, magnetic resonance imaging (MRI) or surgery on brain tumor patients. Over 75 percent of patients underwent such procedures (92 percent in the case of MRI, 87 percent in the case of postoperative radiation therapy).
But, the study discovered that some practice patterns contradict published guidelines. Over 80 percent of the patients received anti-epileptic drugs, where there is little value for patients who do not have epileptic seizures and significant side effects. The infrequent use of chemotherapy may also conflict with published literature. Only 54 percent of patients received chemotherapy, which has been found to correlate with increased survival, though modest.
One of the most surprising findings was the infrequent use of anti-depressant medications (8 percent) for patients with symptoms of depression. "The incidence of depression is very high and very few of these patients are treated for depression. This is one patient management tool that could be implement immediately to help a patients' quality of life," Laws said. Few patients (7 percent) received the drug heparin for blood clots as well, despite the risk of deep venous thrombosis. The study found conflicting literature on the efficacy of low-dose heparin in brain tumor patients.
The JAMA article was the final report on the "Glioma Outcomes Project," a prospective, longitudinal database begun in 1997 that tracked clinical practice patterns and outcomes among North American patients with malignant gliomas at 52 clinical sites, including U. Va. "Now we have a really solid benchmark," Laws said. "This paper tells us a great deal about where we are now and where we need to go in diagnosing and treating malignant brain tumors. When we have studies involving the same kind of patient treated with new ways, we can hopefully answer the questions- is it really better than the treatment standard in 2003 or 2004?"
Journal
JAMA