NICE guidance on the use of carmustine wafers in high grade gliomas: a national study on variation in practice

Abstract

Background. Multidisciplinary team (MDT) working in oncology aims to improve outcomes for patients with cancer. One role is to ensure the implementation of best practice and National Institute for Health and Clinical Excellence (NICE) guidance. In this study, we have assessed the role of MDT in implementing the TA121 appraisal of the use of carmustine wafers in high grade gliomas. Methods. 296 patients with high-grade glioma suitable for maximal resection were recruited from 17 Neurosurgical Centres. The number of patients treated with carmustine wafers and reasons for not using this were recorded. Complications at 48 hours post-operatively and at 6 weeks post-radiotherapy were recorded. Results. 94/296 (32%) of suitable patients received carmustine wafers. In 55% of cases carmustine was not used due to either surgeon preference or a lack of an MDT decision. There was no increased complication rate with carmustine use at either 48 hours post-surgery or at 6 weeks post radiotherapy. Use of carmustine wafers did not decrease access to and use of chemoradiotherapy. Conclusions. One third of patients suitable for carmustine wafers received them. Their use was neither associated with more frequent complications, nor decreased use of chemoradiotherapy. Implementation of NICE TA121 Guidance is extremely variable in different MDTs across the United Kingdom.

Keywords::

• Brain neoplasms
• implementing NICE guidance
• carmustine wafers
• improving outcomes guidance

Acknowledgements

Stephen Price is funded by a Clinician Scientist Award from the National Institute for Health Research. This study was sponsored through an unrestricted educational grant from Archimedes Pharma (Reading, Berks, UK). The funders had no role in the design of the trial protocol; in the collection, analysis or interpretation of the data; or in the writing of the manuscript. pH Associates Ltd (Marlow, Bucks, UK), an independent research consultancy coordinated data collection and analysed the data on behalf of the Study Group. The corresponding author has full access to all the data in the study and had final responsibility for the decision to submit for publication. In addition, IRW, PG and GC have received fees for speaking at Archimedes Pharma sponsored events.

Participating centres and investigators in the UK-HGG Study Group

Cambridge University Hospitals NHS Foundation Trust (79), Stephen Price, Lothian University Hospitals NHS Trust (Edinburgh) (42), Ian Whittle, Shanne McNamara; King's College Hospital NHS Foundation Trust (35), Keyoumars Ashkan; Southampton University Hospitals NHS Trust (32), Paul Grundy; Royal Free Hampstead NHS Trust (18) Lewis Thorne, Jane Baranowski; The Newcastle upon Tyne Hospitals NHS Foundation Trust (18) Joanne Lewis, John Crossman, Lynn Park; University Hospital of North Staffordshire NHS Trust (Stoke on Trent) (17) Jagmohan Singh, Catharine James; Barking, Havering & Redbridge University Hospitals NHS Trust (Romford) (11) Jonathan Pollock, Kim Grove; Lancashire Teaching Hospitals NHS Foundation Trust (Preston) (11) Charles Davies, Julie Law; Brighton & Sussex University Hospitals NHS Trust (Haywards Heath) (9) Giles Critchley, Ja-Eun Kim; University Hospitals Birmingham NHS Foundation Trust (8) Garth Cruickshank, Claire Goddard, Fred Berki; Hull and East Yorkshire Hospitals NHS Trust (Hull)(4) Shailandra Ashawal, Louise Baker Lynne Gill; University Hospitals Coventry & Warwickshire NHS Trust (Coventry) (3) Munchi Choksey, Ian Edwards; NHS Tayside (Ninewells, Dundee) (3) Sam Eljamel; Abertawe Bro Morgannwg University Health Board (Swansea) (2) Rupert Kett-White, Ann Hubschmid; Imperial College Healthcare NHS Trust (Charing Cross) (2) Kevin O'Neill; NHS Grampian (Aberdeen) (2) Emmanuel Labram.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.