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Neuro-Oncology

Guidelines in this section: Refer a patient



Updated 18 August 2009 


The Neuro-Oncology Site Group at the BC Cancer Agency is composed of members from the four B.C. Cancer Agency (BCCA) Cancer Centers and associate physicians involved in patient care, research and teaching with respect to tumors of the CNS system. The group has provincial responsibilities and, as part of its mandate, will recommend management policies for neuro-oncologic diagnoses.


Patients with a pathologic (or occasionally imaging abnormalities highly suggestive of) diagnosis of a CNS tumor can be referred to the BCCA for consultation, treatment or follow-up. Routine referrals are usually seen within 10 working days while emergencies with rapid neurologic deterioration are seen as soon as possible. In addition to the core medical services, access to supportive services such as nursing, patient counseling and speech therapy, as well as referral to community occupational therapy, physiotherapy and home care nursing are also available. Selected uncommon or difficult cases are presented at the multidisciplinary neuro-oncology case conference on Friday mornings. This conference is video-linked to all 4 cancer centers. Referring physicians are most welcome to attend.


All new pediatric referrals should be referred to BC Children's Hospital to neurosurgery or oncology or neuro-oncology.


Despite the intensive treatments for patients with CNS tumors, the survival in some tumor types is short. Some patients may be candidates for participation in clinical trials of the various treatment modalities involved. Patient and Family Counselling Services, at the Vancouver Island and Vancouver Centres, offer Brain Tumour Support Groups to provide social and psychological support for patients and their family members.

See reports required by the Admitting Department.

Driving restrictions may be indicated for brain tumour patients because of seizures or impairment of vision, mobility or cognition.


Seizures

Driving is not permitted for 6 months after a generalized seizure; driving may be resumed after 6 seizure free months if the patient is compliant with an antiepileptic regimen. A patient who previously had a seizure and was on an antiepileptic regimen and who wishes to discontinue the seizure medications must not drive for 3 months. If seizures do not recur during this period, driving privileges may be reinstated. Patients who have a brain tumour diagnosis remain at a higher risk for seizures than the general population throughout their lives and should be advised to consider allowing others to drive whenever possible.


Vision

If there is a visual field defect or other visual impairment, refer to an ophthalmologist for a formal assessment and recommendations.


Mobilty and cognition

If the patient is impaired in mobility or cognition to the extent that this impairment could affect driving ability and the patient wishes to drive anyway, refer to a DriveABLE or drivers rehabilitation program:


http://www.pssg.gov.bc.ca/osmv/driveable

https://www.vch.ca/403/7676/?program_id=11712


In general, driving is not recommended if the brain tumour is not clinically and radiographically stable.


Here is a complete overview of driving fitness for BC physicians.

http://www.pssg.gov.bc.ca/osmv/shareddocs/DriverFitnessMedPro.pdf

Updated September 2007 


Planning for the Radiation Treatments: Mould Room and Simulator


Your treatment planning begins in our radiation therapy Mould Room. The appointment will last approximately 30 minutes. During this appointment, a thermoplastic mask will be made of your head. This involves taking a flat piece of thermoplastic and warming it up in a warm water bath. It will then be stretched over your face and head while you are lying down. It feels warm and wet initially and then the mask will start to harden in about 10 minutes. This mask will hold your head in position during each treatment. 

An hour after you’ve had your mask made, you will have a CT scan done with the mask on. The images acquired during the scan, in addition to information and x-rays previously done, will be used by your radiation oncologist and the treatment planning therapists to develop your personalized treatment plan.


Treatments and Side Effects
Radiation treatments are given once a day, Monday to Friday, over several weeks. Most treatment appointments are between ten to twenty minutes. Most people do not experience any physical sensation during treatment. Your treatments do not make you radioactive.


The treatment may produce a variety of side effects. These depend on the amount of radiation given and the size and location of the area treated. They are due to swelling of the tissues in the brain. They include, but are not limited to, the following:


  • Fatigue: Fatigue is a common side effect of radiation therapy. It usually starts towards the end of the second week of treatment. It can continue for 4-8 weeks, or longer, after treatment has finished. The degree of fatigue experienced varies with individuals. Patients having chemotherapy and radiation at the same time might experience more fatigue. It is possible to decrease this side effect and its impact on daily living. Drinking 8-10 glasses of non–caffeinated fluids a day is important when you are on treatment. Drinking helps flush out the effects of radiation that lead to cellular fatigue. To maintain energy, balance your activities. Walking for 20-30 minutes a day increases the brain chemicals endorphins that contribute to positive mood and energy. Modify but try to continue your normal physical activities. A short nap during the day may also be useful.

  • Headache: Swelling in the brain can cause headaches which should be reported to a member of your health care team. This is very important if you have headaches in the morning or headaches associated with nausea and vomiting. If a preexisting headache becomes more severe or more frequent, this should also be reported. If you are taking Dexamethasone (Decadron), continue to do so as prescribed. The dosage may need to be adjusted and rapid control of symptoms can be expected. If you experience any sudden changes, contact your oncologist immediately.

  • Nausea and Vomiting: Swelling in the brain can cause nausea and vomiting. Please report these or any worsening neurological symptoms to your health care team. Medications can be prescribed or existing medication dosages adjusted.

  • Changes in Sensation and Movement: Contact your oncologist immediately if you experience any of the following: a change in vision, hearing or speech; a change in the feeling in the face, trunk, arms or legs; an abrupt change of bowel or bladder habit; weakness of the arms or legs; unsteady walk; seizure or "blackouts"; or any other changes. You may require important changes in your medication.

  • Loss of Hair: Hair roots are very sensitive to radiation. Gradual hair loss from the area being treated will be noticed between four to six weeks after the start of radiation. This may be temporary (with re-growth within three to six months) or permanent, depending on the amount of radiation received. Skin care instructions will be given to you. Talk to your Registered Nurse about head coverings and wigs.

Decadron

Dexamethasone (Decadron) is a widely used, effective medication which controls brain swelling. There are a number of side effects with this drug, which include increased appetite and weight gain; roundness of the face; stomach acid indigestion; easy bruising; hyperactivity and interference of sleep. Decadron can decrease the warning signs of infection, so any raised temperature or infection must be reported to your health care team. Decadron can also raise your blood sugar. If you are a diabetic or you have been told you are at risk for diabetes, your blood sugar must be monitored.

The lowest dose of Decadron for the shortest time will be used to minimize these side effects. You will be monitored and your Decadron dose adjusted during and after radiation treatment, as necessary. Decadron should not be stopped abruptly without consulting your doctor. Your Registered Nurse can give you an information sheet on Decadron.


Driving 
Patients who have had a seizure are restricted, by law, from driving for 6 months. Patients with problems with their vision, strength, sensation or judgment may also need to stop driving. Your doctor will advise you about driving. Ask your health care team about volunteer drivers. 


After Treatment 
An appointment will usually be arranged for four to six weeks after your last treatment. Medical, social and rehabilitation needs will be assessed then.

​Follow-up

Primary brain tumour patients remain at risk for disease relapse after treatment throughout their lives. Surveillance imaging is typically booked at the treating cancer centre or through the neurosurgeon. Patients are also at risk for late effects of treatment. In addition, patients and family caregivers may experience significant psychological distress as a result of the diagnosis. Please see the attached for more information: Follow-up Program for Brain Tumour Patients.

Updated 6 July 2012

Treating nerve damage (neuropathy) - patient information

"Headlines" - a newsletter for people who have been diagnosed with a brain tumour. 

See our section for patients and the public or call the Library at 604.675.8001 
or toll free: 1.888.675.8001, ext. 8001.

Chemotherapy protocols - neuro-oncology
 
Patient and Family Counselling Services has professionally trained counsellors to provide practical assistance related to travel, finances and accommodation etc. and counselling available to individuals, couples and families. As well, programs such as Art Therapy, Music Therapy, and Relaxation Programs are available. For more information, see the section on Patient and Family Counselling or contact your local cancer centre, Patient and Family Counselling Services (see list of the BCCA centres and telephone numbers below).


Rehabilitation Counselling: is a provincial program, actively run from the Vancouver Centre. It includes vocational counselling, resource referral, information and advocacy assistance and counselling related to rehabilitation issues for patients and family members. Contact: Maureen Parkinson in the Vancouver area 604-877-6098 local 2194 or outside Vancouver at 1-800-663-3333 local 2194.


Vancouver Center (VC) 
The Brain Tumour Support Group was set up at the B.C. Cancer Agency, Vancouver Center in 1985 for patients with primary brain tumours, their families and friends. The meetings are co-facilitated by a counselor and a nurse. The courage, humor, determination and strength of those who attend make this group a highly successful and supportive place to meet others. The Brain Tumour Support Group offers patients, family members and caregivers the unique opportunity to meet with other individuals who are coping with similar issues. Meetings are held on the 1st Wednesday of the month from 9.30-11:00 a.m. in the John Jambor Room on the first floor of the Vancouver Centre.

Tel: 604.877.6000, local 2194 
Toll free (in BC): 1.800.663.3333 local 2194


Vancouver Island Center (VIC) 
The Brain Tumour Support Group at the Vancouver Island Centre group is open to brain tumour patients, their families and friends. This group provides a supportive environment to meet with others who are undergoing or have undergone treatment for a brain tumour—to share experiences and learn from each other.   Guest speakers are occasionally invited. The group is facilitated by a counsellor from Patient and Family Counselling, and happens on the second Thursday of each month from 11:00 – 12:30 pm in the Quiet Room on the second floor. 

Tel: 250.519.5525  
Toll free: 1.800.670.3322 Local 5525


Fraser Valley Center (FV) 
Tel: 604.930.2098
Toll free: 1-800-523-2885 (in BC)

Center for the Southern Interior (CSI)  
Tel: 250.712.3963
Toll free number: 1-888-563-7773

Abbotsford Center (AC)
Tel: 604.851.4710 ext: 645301
Toll free (in BC):  1.877.547.3777 

Chair

Dr. Brian Toyota, 604.875.5233
Vancouver General Hospital (VGH)

Gordon and Leslie Diamond Health Care Centre
2775 Laurel Street, Office #8117
Vancouver, B.C. V5Z 1M9

Members

Dr. Alex Agranovich Radiation Oncology FVC

Dr. Ryojo Akagami Neurosurgery VGH

Dr. Abraham Alexander Radiation Oncology VIC

Dr. Abdul Al-Tourah Medical Oncology FVC

Dr. Andrew Attwell Medical Oncology VIC

Dr. George Cameron Neurosurgery Victoria

Dr. Hannah Carolan Radiation Oncology FVC

Ms. Rosemary Cashman Nursing VC

Mr. Richard Doll Cancer Rehabilitation VC

Dr. Katerina Dorovani-Zis Pathology VGH

Dr. Adam Fleming Pediatrics BCCH

Dr. Chris Fryer Radiation Oncology BCCH

Dr. Francois Germain Radiation Oncology CSI

Dr. Sharlene Gill Medical Oncology VC

Dr. Karen Goddard Radiation Oncology VC

Dr. Charles Haw Neurosurgery VGH

Ms. Norma Hoeppner Pt. & Family Counseling AC

Ms. Eleanor Holwerda Nursing VIC

Dr. Juliette Hukin Neurology BCCH

Dr. Andrew Joaquin Neurosurgery Victoria

Dr. Meg Knowling Medical Oncology VC

Dr. Pamela Leco Radiation Oncology CSI

Dr. Andrew Lee Neurosurgery RCH

Dr. Roy Ma Radiation Oncology VC

Dr. John Maguire Pathology VGH

Dr. Monty Martin Diagnostic Imaging VC

Dr. Heidi Martins Medical Oncology VIC

Ms. Yvonne McCombie Health Info Services VC

Dr. Michael McKenzie Radiation Oncology VC

Dr. Ian McKenzie Pathology VGH

Dr. Wayne Moore Pathology VGH

Dr. Kevin Murphy Medical Oncology FVC

Ms. Fiona Murphy Pt. & Family Counseling VIC

Dr. Alan Nichol Radiation Oncology VC

Mr. Douglas Ozier Pt. & Family Counseling VC

Dr. Howard Pai Radiation Oncology VIC

Ms. Maureen Parkinson Pt. & Family Counseling VC

Ms. Sanna Pellatt Pharmacy VIC

Ms. Amy Rappaport Pt. & Family Counseling VC

Dr. Gary Redekop Neurosurgery VGH

Dr. Delia Sauciuc Medical Oncology CSI

Dr. Ash Singhal Neurosurgery BCCH

Dr. Paul Steinbok Neurosurgery BCCH

Dr. John Sun Neurosurgery Victoria

Dr. Marianne Taylor Medical Oncology CSI

Dr. Brian Thiessen Medical Oncology VC

Ms. Catherine Traer-Martinez Pt. & Family Counseling VIC

Dr. Maria Vlachaki Radiation Oncology VIC

Ms. Brigitte Wagner Pt. & Family Counseling CSI

Dr. Ken Wilson Medical Oncology VIC

Dr. Jane Wilson Radiation Oncology CSI

Dr. Barrie Woodhurst Neurosurgery VGH

Dr. Thomas Zwimpfer Neurosurgery VGH

 

 

Types of cancer

The BC Cancer Agency produces general information on the various types of cancer, including what it is, how it’s treated and where to find support and resources.

SOURCE: Neuro-Oncology ( )
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