In 2012, Oxford Journals issued a supplement of Neuro-Oncology with articles dedicated solely to applied neuro-oncology (Neuro Oncol 2012 Sep; 14(Suppl 4): 1–108). Topics ranged from palliative care and quality of life to molecular markers and ongoing developments in personalized medicine. The overwhelming positive response to the supplement made clear the need for a journal devoted to clinical issues in neuro-oncology. With the generous support of the National Brain Tumor Society, the Society of Neuro-Oncology and Oxford University Press (OUP) have collaborated on launching this new journal, Neuro-Oncology Practice, as a complement to Neuro-Oncology.
It is a privilege to serve as the Editor in Chief for Neuro-Oncology Practice and I am excited to work with distinguished co-editors from the various international neuro-oncology societies- Jeff Wefel, Wolfgang Grisold, and Rakesh Jalali- to ensure the highest quality of publications. We are joined by a multidisciplinary and global team of associate editors and editorial board members who have enthusiastically supported this initiative through their willingness to review articles and to actively solicit manuscripts from colleagues. I am especially grateful to the managing editors Elizabeth Martinson (OUP) and Ilona Garner (University of California, San Francisco) and the incredible staff at OUP who have been instrumental in ensuring a smooth launch of the journal.
As the knowledge base regarding the basic science and translational aspect of brain tumors rapidly expands, we hope that this journal will provide a forum for review and discussion of applying this information to the clinical arena. We envision that this journal will not only be of interest to clinicians and allied health professionals in the field of neuro-oncology but will also be of relevance to general oncologists and those caring for patients with brain tumors, whether primary or metastatic.
The new journal will focus on several topics including:
The application of new trial results to improve standards of patient care;
Translation of scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies;
Raising awareness of current practice and research opportunities in the areas of symptom management, survivorship, neurocognitive/neuropsychological function, palliative care, end-of-life issues and caregiving.
This first issue contains both useful reviews and original articles to consider in our everyday practice. Recognizing that brain tumor patients develop unique symptoms and needs throughout their disease trajectory and that the majority lose the ability to communicate during the end-of-life phase, Tobias Walbert reviews the integration of palliative care (PC), hospice care and end-of-life care for these patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology are reviewed and patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey of the neuro-oncology community. The finding that despite a very high symptom burden, many high-grade glioma patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations provides an important basis for early integration of PC interventions and structured advanced care planning to improve symptom control and quality of life for brain tumor patients.
Also addressing this important aspect of care, Andrea Pace and colleagues describe an innovative pilot program of comprehensive palliative care for brain tumor patients in the Regina Elena National Cancer Institute of Rome, supported by the Lazio Regional Health System. The aim of this model of assistance was to meet patients' and families' needs of care in all stages of disease and to reduce the hospitalization rate at the end of life. The efficacy of the model of care was evaluated by analyzing place of death, caregiver satisfaction, quality of life, hospitalization rate, and the impact on health system costs. From October 2000 to December 2012, 848 patients affected by brain tumors were enrolled in a comprehensive program of neuro-oncological home care. Their findings suggest that a neuro-oncologic palliative home care program has a positive impact on the quality of care of brain tumor patients, particularly at the end of life.
Neuro-oncologists are most familiar with primary parenchymal brain tumors and intracranial tumors such as meningioma, intracerebral metastases, and meningeal carcinomatosis. However, brain cancer can also involve structures around the brain including the dura, the base of the skull, the cavities of the skull, and the tissue of the neck and can either compress, invade, or spread in the central or peripheral nervous system. Wolfgang and Anna Grisold comprehensively review the complex symptoms and signs, sites of tumor spread, diagnostic tools, mechanisms of cancer spread involving cranial nerves, and treatment of cancer around the brain. This is an important resource for clinicians who care for patients with these challenging clinical scenarios.
Cerebrovascular accidents (CVA) are a significant risk for patients with pituitary tumors, and Paul Brown and colleagues sought to assess the risk of CVA and second brain tumors in patients with pituitary adenoma after surgery or radiotherapy. A cohort of 143 patients was followed for a median of 15.5 years and there was no difference in CVA-free survival between treatment groups. Even with long-term follow-up, second brain tumors are a rare event regardless of treatment modality. This provides clinicians with important information for counseling patients with pituitary tumors in terms of long-term risks.
I would like to thank the authors for their contributions to this inaugural issue and look forward to working with the editorial board members and members of the neuro-oncology community in providing a high-quality journal with clinical relevance to the field of neuro-oncology.