Table 1

Neurosurgical: Royal College of Physicians guidelines

CT, computed tomography; GP, general practitioner; ICP, intracranial pressure; MRI, magnetic resonance imaging; WHO, World Health Organization.
The diagnostic phase
  • Image diagnosis should be made by CT scan with contrast or MRI scan (CT or MRI are not accurate predictors of tumour type therefore histological confirmation must be actively considered and usually undertaken)

  • Performance status should be recorded before surgery—for example, Karnofsky

Breaking the news of diagnosis
  • News of the diagnosis and information about the prognosis should be imparted in an appropriate environment (a quiet, private place rather than a public setting; ideally no more than two health professionals should be present. Most patients want a partner/close relative there when being told of the diagnosis)

  • After each consultation and treatment a brief written summary of specific rather than general details of what has been disclosed should be included in the notes

  • An opportunity should be made for relatives to ask further questions when the full impact of the diagnosis has been absorbed

  • Ensure the patient has a clear enough idea of prognosis to be able to weigh up the merits and drawbacks of treatment

Corticosteroid treatment
  • Treatment centres should develop written guidelines for the use of steroids

  • Patients and their relatives must be given written guidance about steroid medication and instructions about the manner in which the dosage may be altered

  • Steroid dosage should be reduced to the lowest amount compatible with the control of neurological symptoms and discontinued, if possible, after radiotherapy treatment

  • Resection of a malignant glioma is justified to give rapid relief from distressing symptoms (for example, raised ICP) or when the tumour is in a non-eloquent area and the risks of resection are considered acceptable

  • When debulking is carried out complete macroscopic resection is preferable to partial removal

  • Where biopsy is considered in preference to more extensive resection, image directed biopsy should be used rather than freehand needle biopsy (histological reporting should be available if necessary at the time of operation)

  • Histological reporting should use one of the accepted grading systems (WHO or Daumas Duport)

  • Provide clear written information explaining basic facts about the disease and its treatment, to back up consultations and reduce the chance of patients receiving conflicting information about their disease

  • Early postoperative imaging (48−72 hours) should determine the extent of tumour resection

  • Performance status should be recorded in case notes before discharge

  • Patients should be informed of legal requirement to inform the driving licence authority (DVLA) and this documented in the notes

Support and follow up of patients
  • Treatment/care should be planned in a coordinated fashion

  • Care should be ideally supervised by a single specialist and team, and a key coordinator (for example, nurse)

  • All patients should have access to oncological advice

  • Patients and relatives must know a main point of contact for advice/support at all stages of illness

  • The patient’s GP should always be informed of the diagnosis before the patient needs to see them

  • The discharge summary should contain details of arrangements for follow up and management

  • Patient information leaflets should be available in the department, accessible and well displayed

  • Information should be given about further sources of support as provided by national organisations.