CLINICAL NEURO–ONCOLOGY ROTATION
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Introduction
Objectives
a. General
b. Specific
Staff
Trainees who may benefit from this elective
Duration
Activities
Procedures
Weekly schedule
1.
Introduction.
A neuro-oncologist was recruited in 2005 with the aim of providing care to not only patients with primary and metastatic
brain tumors, but also to any cancer patient with neurological symptoms or complications. We are seeing more of these
patients in the clinic and at the West Jefferson Medical Center because we are the only institution in the Southern Gulf area
with a well-assembled neuro-oncology team. This resource offers an enormous learning experience to residents and
fellows, and at the same time stimulates an environment of interdisciplinary work that interfaces Medicine, Neurology,
Neurosurgery, Oncology, and Radiation Oncology. Our patients from Louisiana and neighbor states will be the ultimate
beneficiaries of this effort. We hope it will be a time–intensive yet rewarding rotation.
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Objectives.
a. General:
i. To introduce trainees to the discipline of Neuro–Oncology
ii. To help develop in trainees a standardized approach to the cancer patient with neurologic symptoms or
complications
iii. To help develop in trainees a standardized approach to the patient with primary brain and spine tumors
iv. To help develop in trainees a standardized approach to the patient with brain and spine metastases
v. To prepare residents for neuro-oncology questions in the American Board of Psychiatry and Neurology Board
Exam
vi. The residents will receive instruction in appropriate and compassionate methods of end-of life palliative care,
including adequate pain relief and psychosocial support and counseling for patients and family members about
these issues.
b. At the end of this elective, trainees should:
i. Efficiently evaluate the mental status of patients in the office or at the bedside, and conduct time–efficient,
focused neurological exams for anatomical localization
ii. Based on the data collected from the history, physical exam, and ancillary studies, formulate a diagnosis, make
treatment recommendations, and establish a prognosis
iii. To become familiar with the Karnofsky Performance Score (KPS) as the most commonly used performance
scale used in Neuro–Oncology, and the recursive partitioning analysis (RPA) classes for prognosis in brain
metastases
iv. To be familiar with the pathology, radiology, prognosis, and current treatment options for:
1. Glioblastoma multiforme
2. Anaplastic astrocytoma
3. Anaplastic oligodendroglioma
4. Low grade gliomas (astrocytomas, oligodendrogliomas, or mixed)
5. Meningiomas: benign, atypical, malignant
6. Brain metastases
7. Leptomeningeal disease
8. Other tumors: skull base, head and neck, primary CNS lymphoma
v. To break bad news to patients and families in a compassionate, human, and empathetic way
vi. To promptly recognize and treat the following emergencies or complications:
1. Intracranial hypertension, with or without brain herniation
2. Seizures
3. Spinal cord compression
4. Delayed neurotoxicity from radiation therapy
5. Polyneuropathy from chemotherapeutic agents
6. Neuropathic pain
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Staff: Ivo W. Tremont, M.D., Frank Culicchia, M.D.
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Trainees who can benefit from this rotation: Neurology, Medicine, Hematology–Oncology, Radiation Oncology, and
Neurosurgery residents or fellows
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Duration: One month at least
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Activities: Clinic, inpatient consults, inpatient rounds, family conferences (if applicable), operating room (OR, optional),
tumor board.
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Procedures (when indicated): Lumbar puncture, intrathecal administration of chemotherapy; Puncture of Ommaya
reservoirs and intraventricular administration of chemotherapy
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Weekly schedule
Time
AM
PM
Monday
Rounds,
Clinic
Clinic
Tuesday
Rounds
Clinic
Clinic
Wednesday
Tumor Board
Clinic
Consults
Rounds
Thursday
Consults
Rounds
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Friday
Rounds
Clinic
Clinic
References
We will follow the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology, v.1.2006 on CNS
Cancers, and the World Health Organization textbook on the Pathology of Tumors of the Nervous System IARC Lyon, 2000
SUB-SPECIALTY: Neurology
ROTATION EXPERIENCE: Inpatient Neurology Service
PATIENT CARE
Neuro-Oncology Patient Care
Objectives
Teaching Methods
Assessment Strategy
Introduce the trainee to the basic principles & desiplines of
Neuro-oncology
Clinical Teaching
Review of guidelines
Global ratings
Gather essential patient history and data to formulate a
diagnostic differential
Develop a standardized approach to the patient with primary
brain & spine tumor
Clinical Teaching/Patient Care
Global ratings
Clinical Teaching
Direct Patient Care
Global ratings
Case Conference Evaluations
MEDICAL KNOWLEDGE
Neuro-oncology Medical Knowledge
Objectives
Familiar with the Karnofsky Performance Scale (KPS)
Familiar with the pathology, radiology, prognosis and current treatment
options for:
1. Glioblastoma multiforme
2. Anaplastic astrocytoma
3. Anaplastic oligodendroglioma
4. Low grade gliomas (astrocytomas,
oligodendrogliomas, or mixed)
5. Meningiomas: benign, atypical, malignant
6. Brain metastases
7. Leptomeningeal disease
8. Other tumors: skull base, head and neck,
primary CNS lymphoma
Teaching Methods
Clinical Teaching
Required Reading
Clinical Teaching
Case Conference
Assessment Strategy
Global ratings
End of Rotation Quiz
End of Rotation Quiz
INTERPERSONAL AND COMMUNICATION
Neuro-oncology- Interpersonal and Communication
Objectives
Learn to break bad news to patients & families in a
compassionate, human and empathetic way
Present Cases in a organized and detailed manner
Demonstrate the ability to compassionately relate to the family of
a patient
Teaching Methods
Patient Care
Assessment Strategy
Global ratings
Case Conference
Modeling
Clinical Practice
Modeling
Global rating
Teaching Methods
Case presentations
Assessment Strategy
Global ratings
End of Rotation Quiz
Case presentations
Clinical Care
Global ratings
End of Rotation Quiz
Teaching Methods
Clinical care
Modeling
Assessment Strategy
Global ratings
Teaching Methods
Modeling
Clinical Teachings
Direct patient care
Clinical Teachings
Assessment Strategy
Global ratings
Global ratings
PRACTICE BASED LEARNING AND IMPROVEMENT
Neuro-oncology Practice Based Learning and Improvement
Objectives
Research clinical questions regarding potential treatments for their
patients, using information technology to access on-line medical
information
Familiar with published clinical care guidelines
PROFESSIONALISM
Neuro-oncology Professionalism
Objectives
Interact responsibly and compassionately with patients, families
and co-workers
SYSTEM BASED PRACTICE
Inpatient Neurology Service (PGY1 or 2) System Based Practice
Objectives
Develop an understanding of cost effective health care
Advocate for patients when dealing with resource allocation issues
and complex payer system problems
Global ratings