NEUROLOGY UPDATE

DR E. MOLINARI

QUEEN ELIZABETH UNIVERSITY HOSPITAL

GLASGOW

SANON 2018 National Meeting

TALK OVERVIEW QPI

Neurologists in context - changing needs - JLA - financial boost

What we do

What we would like to do

Howe we would like to do it

Coming up soon

NATIONAL CLINICAL AUDIT

PROGRAMME 2017-2018

QPIs

standard of care across all locations

quality performance indicators

Improving QPI 11

against a target of 95%

compared to 77.9%

84.1%

BTs DEDICATED NEUROLOGISTS

Are we important?

Are we dealing with similar conditions?

Can we learn from other neurological conditions?

Epilepsy

…there is a mass in the brain…

Transforming Care After Treatment (TCAT)

support people with the physical, emotional and

financial issues

NEURO-ONCOLOGY NEUROLOGISTS

Socio-economic impact of BTs survivorship

Halving the harm of BTs

JLA Neuro-Oncology Top 10

1. Do lifestyle factors (e.g. sleep, stress, diet) influence tumour

growth?

4. In second recurrence glioblastoma, what is the effect of

further treatment on survival and quality of life, compared with

best supportive care?

7.What are the long-term physical and cognitive effects of

surgery and/or radiotherapy?

9.What is the effect of additional strategies for managing fatigue,

compared with standard care?

10. What is the effect of extent of resection on survival in people

with a suspected glioma?

Neuro-Oncology Top 10

JLA

JLA Neuro-Oncology others priorities

• what is the effect of short-course steroid use, compared with

continuous steroid use, on managing symptoms?

• what is the effect of cognitive interventions (including memory

training) on improving memory after radiotherapy, compared

with standard care?

• what is the effect of management of depression on outcome,

compared with standard care?

• what is the effect of adopting a healthy diet on progression-

free survival?

FUNDING BOOST

• Department of Health & Social care £ 45 million

• National Institute for Health Research £ 20 million

• Cancer Research UK

• NIHR and DoH

£ 25 million £ 13 million/year

NEURO-ONCOLOGY NEUROLOGISTS 1

“when I go in the other room, they look at my

tumour”… “when I am here, you look after me”

Complementary MDT areas

NEURO-ONCOLOGY NEUROLOGISTS 2

Oncology

NEURO-ONCOLOGY NEUROLOGISTS 3

Secondary Epilepsy

Cognitive difficulties

Emotional difficulties

Physical difficulties

Neuropsychology

Psychiatry

Neuro-

rehabilitation

Health surveillance Integrate care

Neurosurgery

Clinical

Scope Diagnosis

Monitoring & Managing brain tumours in adults

Aims To improve diagnosis & standardize care

NICE GUIDELINES 2018

RESEARCH OPPORTUNITY

Research

Funding

Trials Laboratory

Neuroscience University NHS

INCREMENTING THE WHEEL

TIME TO… UPDATE

Several labs

NEURO-ONCOLOGY NEUROSCIENCE 1

Several teams

Inflammation

Regenerative

Medicine

Research

Imaging

Dementia &

Stroke

MS research

Demyelination

How lab skills in neuroscience could expand and

incorporate neuro-oncology

NEURO-ONCOLOGY NEUROSCIENCE 2

Mechanism of tumour-associated epilepsy

Mechanism of tumour-associated symptoms (HRQoL)

Mechanism of treatment-related symptoms

Basic science of Inflammation and immuno-therapy

Drugs combining seizure and tumour control

Biomarkers for risk-stratification on QoL

Inform on therapeutic strategies

Guide treatment decisions

Evaluate treatment global effects

NEURO-ONCOLOGY NEUROSCIENCE 3

Improve QoL

NEUROLOGY UPDATE

Plan for a position statement and future landscape

Research projects

Moving forward

Is it “normal brain" or not?

changes around tumour

changes far away from tumour

Clinical trials

Better assess symptom burden and QoL

Better incorporate PROs

Anti-epileptic medications

NEUROLOGY UPDATE.1

NEUROLOGY UPDATE.2

SPRING trial Seizure PRophylaxis IN Glioma

Use of diet in gliomas Cochrane Review

SCAN-LGG Symptoms Correlates And

Neuroimaging in Low Grade Gliomas:

addressing the quality of life

Incorporation of QoL

Neuro-Oncology Practice,npy032

Recent Incubator Day

RANO-PRO working plan

Thanks for the attention

emanuela.molinari@nhs.net