Collaborative Care Beyond the Cancer Silo for Brain Cancer Patients

Recently, I was at an education day run by a metropolitan hospital and aimed at increasing the awareness of the needs of patients with brain tumors.

One of the sessions looked at multidisciplinary care and encouraged the use of this particular hospital's acquired brain injury (ABI) unit. The speaker made the most valid point that, really, our brain cancer patients have an acquired brain injury after surgery, and the services they require are often offered by ABI units. She suggested the use of an ABI service as a secondary consultancy: Develop a relationship with the service providers, and (excuse the pun) pick their brains for information on a case-by-case basis.

I thought it was a brilliant example of utilizing available services to fill a gap that is underfunded and under-recognized.

I had a chance to use this advice a few weeks later when a gentleman was referred to me for supportive care. He had just been discharged from a metropolitan hospital following resection of a GBM, and he was considered unsuitable for other treatment. However, he wasn't terminal enough for hospice care, old enough for a nursing home, or unwell enough to obtain home nursing care. So home he went with his wife, three tween children, and no support.

Somehow, his wife found my number and rang. She was beside herself with stress and worry. Her husband had behavioral changes that she couldn't control and her children didn't understand. He was aggressive and depressed at times, and he was very forgetful. She had to continue working to pay the bills, and the patient couldn't work, drive, or be left home for long periods. The next oncologist appointment was months away, and she didn't know what to do. On examination, she needed the most support with his behavioral changes and with helping the children cope.

On the phone I jumped to the local ABI unit to see if the people there could help. It took a couple of conversations to get them to see that I could take care of the cancer aspect of the care, but I needed help with the brain injury side of things. As expected, the first answer was that they're not funded for cancer patients, but as the conversation progressed, they began to see what was needed, and they were happy to make contact with the family.

A couple of weeks later, I got in touch again to see how things went. The family was coping much better now that they had access to the appropriate information. The intervention by the most appropriate service, even though it wasn't a cancer-based service, obtained that holy grail for which we all strive: a good patient outcome.

Working outside the silo of cancer care was the only way we could do this. Working collaboratively was the best way to make the most of the services or options we had -- improving networking between services that may otherwise have never been explored outside of their own patient groups.