Contrasting multidisciplinary clinic follow up for patients with high and low grade glioma.

Patients with high grade glioma (HGG) and low grade glioma (LGG) may enter a period of stability in their disease when surveillance is required; during this time they often require different forms of support. We describe two different multidisciplinary clinics approaches to patients with gliomas, both of which are linked to the relevant multidisciplinary meetings (MDMs). Since 1987 the ‘joint glioma clinic’ (HGG clinic) has been run with a neurosurgeon, neurooncologist and clinical nurse specialist seeing patients and their carers in one room. Patients under surveillance undergo MRI scans and if there is evidence of recurrence then an immediate discussion can be held with the patient regarding options for further management. Since 2011 the Low grade glioma clinic (LGG clinic) has run with a multi room model. There are two neurosurgeons, a neurooncologist, a neuroradiologist, a neuropsychologist, a neurologist and a clinical nurse specialist present who discuss patients in a MDM. Subsequently a patient may then see one or more of the team in sequence in different rooms as needed. This allows issues such as epilepsy, neuropsychology, treatment options and surveillance intervals to be discussed with patients at one visit. There is a cohort of 106 patients under surveillance in the HGG joint glioma clinic and 270 patients in the LGG clinic. We believe a single visit can minimize the impact of the disease and provide different forms of support a needed. Both models allow rapid decision making when the period of surveillance ends due to transformation or recurrence.