Doernbecher Children's Hospital Offers Oregon's First Comprehensive Brain Tumor Clinic for Children
04/04/01 Portland, Ore.
Appointments With Multiple Physicians Now Take Half the Time and Are More Comprehensive
Eight-year-old Sam Bishop of Portland was diagnosed with a brain tumor when he was only 10 months old. Since then follow-up clinic visits for his family have required going from the oncologist's office one day to the neurosurgeon's the next, spending several hours at the clinic each day. On several occasions when Sam's magnetic resonance imaging (MRI) scan showed that his brain tumor had grown, the Bishops waited several days for the oncologist and neurosurgeon to find an opportunity to discuss his case and get back to them with a treatment plan.
"When you get bad news like that, you don't want to wait," said Meg Bishop, Sam's mom.
The Bishops don't have to wait anymore. Physicians at Oregon Health Sciences University's Doernbecher Children's Hospital have come up with a new approach to improving communications with families and the outcomes of their patients. Brain tumors are the No. 1 cause of cancer deaths in children and the second most common form of cancer. They also are the most complex to treat, requiring the input of multiple specialists.
Oregon's first Comprehensive Brain Tumor Clinic at Doernbecher combines the multidisciplinary expertise of neurosurgeons, pediatric oncologists, radiation oncologists, nurse practitioners, physical therapists and psychologists. Instead of sending kids and their families to a variety of specialists at different locations, possibly on separate days, they now can get the advice of all the experts who specialize in brain tumors in one simplified visit, often on the same day as their MRI scan.
Now when a patient comes in for a follow-up visit, the neurosurgeon and oncologist can review the MRI scan together. If there is an unexpected problem, they can immediately consult, come up with a plan quickly, and communicate it to the family immediately. This streamlining of services also improves the patient's chances for recovery by providing a higher level of care with an integrated plan.
One of Sam's most recent clinic visits only took two hours and included starting an intravenous line, a MRI scan and a checkup with both the oncologist and neurosurgeon. This same visit used to be a two-day, nine-hour ordeal for the Bishops. The biggest advantage of this new clinic is that the family got one opinion from both specialists instead of two opinions at different times.
"Time is of the essence with brain tumors. The sooner we identify a relapse, develop a course of action and treat the tumor, the better the patient's chances of surviving," said H. Stacy Nicholson, M.D., M.P.H., pediatric neuro-oncologist at Doernbecher.
"This program combines the best team decision making for patients and families with cutting-edge surgical and medical technology. We can offer the best health care to children in Oregon with brain tumors," said Nathan Selden, M.D., Ph.D., pediatric neurosurgeon.
As a team the clinic offers many forms of cancer treatment. Two of the most powerful include new chemotherapy drugs and a 3-D surgical navigation computer to successfully remove tumors. Currently Doernbecher's Brain Tumor Clinic is participating in nine clinical trials to investigate which new chemotherapy treatments are the most effective and have the least side effects.
Selden uses a minimally invasive 3-D surgical navigation computer called a sterotatic system or Stealth, to assist in delicately removing deep brain tumors. The computer allows Selden to remove the tumor without damaging the brainstem, cranial nerves or other vital brain structures. This technology is only about 10 years old and is just now being used in pediatric neurosurgery. Selden treats two to three patients every month with this technique.
Six-year-old Tyler Jacobs is a brain tumor survivor thanks to the Stealth. The Vancouver, Wash., boy experienced a personality change, speech problems and progressive seizures. A MRI scan revealed a brain tumor deep within the bottom of his brain, which was pressing against his brainstem. Selden used the Stealth computer to find the tumor and determine the safest path to reach it. While removing the tumor, Selden, saw the brainstem and deep cranial nerves through a thin veil of spinal fluid, but using the Stealth's navigational device, they avoided injuring these vital structures.
Tyler's tumor turned out to be non-cancerous. He now is free of seizures and his speech is improving. MRI scans since the surgery show the tumor is completely gone. Selden said Tyler has a more than 95 percent chance of being cured. Only weeks after the surgery Tyler was able to attend the Hazel Dell, Wash., little league baseball World Series games in Williams Port, Penn., as a special guest of the team. This spring his dad said Tyler is playing baseball for the Hazel Dell little league.
"I am amazed by how quickly he recovered," said Brad Jacobs, Tyler's dad.
"We feel very fortunate that they got all of the tumor. Now he's his happy little self again," said Laura Jacobs, Tyler's mom.
The clinic hopes to expand its services to include having nurse practitioners visit schools in the community to educate students. In addition, basic research efforts at OHSU and Doernbecher into the genetic causes and characteristics of childhood brain tumors will lead to future therapies that will be tested in the clinic in years to come.