Brain Tumor: Understanding Your Disease
How to Choose a Doctor and Hospital for Your Treatment
Hospitals and doctors are not all alike…
...they vary in quality due to differences in their training, experience and services. These differences in quality become greater and matter more when you need sophisticated medical care for a complex condition.
A surgeon who performs a complex procedure often, for example, has better results with it than a surgeon who does the same procedure only occasion-ally. The complication rate, death rate and effectiveness of the same procedure may be many times higher at one hospital than another.
Clearly, the doctor and hospital that you choose have a direct impact on how well you do — especially when you need treatment for a condition as serious as a brain tumor.
Each year in the United States, more than 21,000 adults and 1,500 children are diagnosed with non-malignant and malignant primary tumors that develop in the brain. Brain tumors can be fatal, but with early diagnosis and state-of-the-art treatment, many non-malignant and some malignant tumors are curable. Long-term survival rates are as high as 95% for some types of nonmalignant tumors and 80% for some tumors that are malignant.
Brain tumors in children are uncommon, and doctors still have much to learn about their diagnosis and treatment. But, thanks to advances made through clinical trials, many pediatric brain tumors are now curable. Historically, many childhood brain tumors were almost always fatal. Today, half of children with brain tumors live at least five years after diagnosis, and 80% of children with brain tumors go into remission, a period during which the tumor does not progress and may be shrinking, and symptoms are decreased or absent.
A multidisciplinary team approach involving physicians from many specialties is generally considered the best way to obtain accurate diagnosis and provide optimal treatment for brain tumors. The team may include neuropathologists, diagnostic and interventional neuroradiologists, medical oncologists, neuro-oncologists, neurosurgeons, radiation oncologists, and surgical neuro-oncologists (whose roles are defined in the box at left), as well as oncology nurses, physical therapists, occupational therapists, psychologists, social workers and dietitians. Team members consult, discuss and agree upon the diagnosis and together determine the most appropriate treatment for the patient.
Selecting a doctor and hospital for treatment of a brain tumor involves making some difficult and critical decisions. No one has more at stake; it is one of the most important decisions of your life. The questions we suggest and the comparisons we talk about in this guide are intended to help you make your decision.
Sidebar
Physicians Who Diagnose and Treat Brain Tumors
Neuropathologist – A physician with special training and experience in analyzing changes in brain and related tissue.
Diagnostic neuroradiologist – A physician with special training and expertise in interpreting X-rays or scans that show the location and size of a tumor.
Medical oncologist – A physician with special training and experience in the medical treatment of cancer by means of different types of drugs and chemotherapy.
Neuro-oncologist – A physician with special training and experience in the medical treatment of brain tumors by means of drugs or chemotherapy. This physician provides follow-up care after treatment.
Radiation oncologist – A physician with special training and experience in treating tumors by means of internal and external radiation.
Interventional neuroradiologist – A physician with special training and experience in specialized, invasive diagnostic and therapeutic techniques for brain tumors.
Surgical neuro-oncologist – A neurosurgeon with special training or experience in removing central nervous system tumors.
How Do You Judge Quality?
Most of us do more research when we buy a car or a television set than when we choose a doctor and hospital. That may be because we don't know what questions to ask or what to base our evaluation on. There are few consumer magazines that rate doctors and hospitals the way Consumer Reports rates air conditioners.
Quality of care can be measured in many different ways, and no universal agreement exists on which should be used. At The Cleveland Clinic Foundation, however, we believe that you can use the following six points, or quality indicators, to compare health care providers:
- Credentials
- Experience
- Range of services
- Participation in research and education
- Patient satisfaction
- Outcome
Choosing a doctor or hospital is often influenced by values. You may want to go to a hospital that is close to home. You may want a hospital with a specific religious affiliation. But when you need specialized medical and surgical care for a brain tumor, you also should consider a doctor's qualifications and a hospital's outcome record. These quality indicators will help you make that kind of evaluation.
Sidebar
A Step-by-Step Guide
This brochure deals with primary brain tumors in adults and children and helps you choose a doctor and hospital by:
- explaining brain tumors and the differences between malignant and nonmalignant tumors;
-describing how brain tumors are diagnosed;
-explaining the treatments available for brain tumors, including surgery, radiation, chemotherapy and immunotherapy;
-explaining six points that indicate quality; and
-providing questions and answers from the Cleveland Clinic that you can use to compare doctors and hospitals.
Brain Tumors
Any mass or growth of abnormal cells occurring in the brain tissue, skull, supportive tissue around the brain, cranial nerves, or the pituitary or pineal gland can be a brain tumor. Primary tumors are those that develop in the brain; secondary brain tumors originate somewhere else in the body and spread to the brain.
Primary brain tumors
Primary tumors may be malignant or nonmalignant.
Malignant, or high-grade, tumors contain cancer cells. They grow rapidly and invade the healthy tissue around them. Eventually, a malignant tumor will crowd out or destroy the normal cells and interfere with their function. Malignant tumors are life-threatening.
Nonmalignant, or low-grade, tumors may also invade surrounding tissue, or coexist with normal cells. Despite this they can cause severe neurologic impairment, such as seizures, behavioral changes and memory loss, and can interfere with normal, vital brain functions. Some low-grade brain tumors are life-threatening.
The National Cancer Institute (NCI) of the National Institutes of Health (NIH) has dozens of classifications for brain tumors, based on where in the brain they arise and their characteristic growth pattern. Each type of tumor has a recommended, accepted treatment regimen and a different prognosis.
Secondary brain tumors
Tumors from other areas eventually spread to the brain or rest of the nervous system in 25% of cancer patients. These secondary brain tumors are always malignant. They cause seizures or loss of vital brain function, and are potentially fatal.
How are brain tumors diagnosed?
Brain tumors are diagnosed using sophisticated computer technology that images the brain in various ways. Computerized tomography (CT) uses a computer and X-rays to make a picture of the brain. Magnetic resonance imaging (MRI) or spectroscopy (MRS) create a brain image using magnetic fields and radiowaves. Other imaging techniques that may be used to assist in the diagnosis and treatment of a tumor include digital subtraction angiography (DSA), magnetic resonance angiography (MRA), positron emission tomography (PET), and single photon electron computerized tomography (SPECT).
In addition to their usefulness at the time of initial diagnosis, these technologies may also allow early detection of a brain tumor recurrence, which facilitates earlier treatment.
Most patients with a brain tumor undergo a biopsy, the surgical removal of a tissue sample from the tumor, either alone or as part of the surgical removal of a tumor. A neuropathologist examines the sample under a microscope to confirm the diagnosis, classify the tumor more specifically by the type of cells it contains, determine how abnormal the tumor cells are (histologic grade) and determine how quickly it is growing. Subtle but critical differences in cells that the pathologist detects under the microscope are critical in making the correct diagnosis, which is used in determining further testing and appropriate treatment for each patient.
How are brain tumors treated?
Brain tumor specialists choose the appropriate treatment for an individual based on the type of brain tumor, its grade, and the patient's age and general state of health. They also base their decision on past experience with various treatments for specific types of brain tumors.
At a multidisciplinary brain tumor center, specialists from many disciplines discuss each patient and provide input on treatment recommendations. Each patient's individualized care plan is developed based on the team's recommendations with consideration of the patient's special needs. The treatment plan may include surgery, radiation therapy, chemotherapy, gene therapy, immunotherapy or a combination of these.
Effective ways to manage side effects of primary treatments and improve quality of life during treatment are available. The potential need for these therapies and their availability are important considerations in treatment planning.
Surgical resection, the removal of as much of the tumor as possible, is a primary treatment for malignant and non-malignant brain tumors. Although many patients are still treated with conventional craniotomy (open-skull) procedures that require large openings, computer-assisted frameless stereotactic techniques are the state of the art in neurosurgery.
Instead of using a stereotactic headframe to help locate the tumor, this new system uses a "sonic wand" or other device in combination with computer-generated, three-dimensional images that allow the surgeon to rehearse the steps of the operation, plan the surgical approach, and identify structures in the brain. This navigational system also allows the surgeon to identify areas of brain tissue that control important functions such as speech or memory and plan the surgery to minimize disturbance to these areas. Using frameless stereotaxy, the surgeon can remove the tumor by making an opening in the skull as small as 1 inch.
For the patient, frameless stereotactic surgery reduces the risk of neurological and wound-healing complications and can result in a shorter hospital stay and recovery period.
Radiation therapy is the use of high-energy X-rays to kill tumor cells. In conventional external radiation, a machine outside the body generates the radiation which is delivered daily to a tumor. It is supplemented by an array of new techniques that may be applied to specific types of tumors. These include:
Stereotactic radiosurgery (photon knife or Gamma-Knife®): applies a single dose of very focused radiation directly to the lesion over 30 to 60 minutes. This method is so effective in many secondary tumors it often eliminates the need for surgery. It is also used for some primary tumors located deep inside the brain that were once considered otherwise inoperable. It can also be applied to tumors in some patients who have reached the safety limit for whole brain radiation.
Brachytherapy (implanted radiation): puts radiation-producing materials (radioisotopes) through thin plastic tubes into the area where the tumor cells are found.
Hyperfractionated radiation therapy: delivers two fractions of radiation per day, six hours apart. This allows for a higher total daily dose which can be more effective in controlling some types of tumors.
Hypofractionated radiation therapy: delivers higher levels of radiation in fewer treatments than conventional radiation therapy. By reducing the frequency of treatments, this technique allows patients who are too ill to undergo daily radiation to benefit from radiation therapy.
Hyperthermia: heats the tumor. Used in combination with brachytherapy, it may enhance the effects of the therapy.
Radiation therapy in children is very demanding because of the brain's small size and the risk of threatening normal brain growth and development.
Chemotherapy involves the use of drugs to kill tumor cells. Innovative treatments for brain tumors include effective new drugs; high-dose chemotherapy combined with bone marrow transplantation for some patients with certain types of tumors; and new administration techniques such as continuous infusion. Intrathecal infusion, in which the drugs are put directly into the spinal fluid, is used to treat patients with certain types of brain and spinal tumors. Growth modifiers, a new type of chemotherapeutic agent, reduces the rate of cell growth but does not kill the tumor directly. These agents may prove to be important additions to drug therapy for brain tumor patients.
Immunotherapy includes biologic response modifiers that are manufactured in the body or synthesized in a laboratory. These substances can kill cancer cells, change the body's response to cancer by directing or restoring natural defense mechanisms, or decrease the side effects of other treatments.
Sidebars
Tumor Grades
Doctors often refer to primary adult brain tumors by grade, from I to IV. The neuropathologist determines a tumor's grade by the way the cells look under a microscope. Cells from higher grade tumors are more abnormal looking and reproduce faster than cells from lower grade tumors. The higher the grade of a tumor, the more malignant it is.
Computer-assisted Stereotaxis in Diagnosis and Treatment
Computer-assisted stereotaxis is a valuable technique for performing biopsy, surgery and radiation therapy. In traditional stereotaxis, the patient wears a special halo-like headframe, and CT scans or MRI create a three-dimensional computer image that pinpoints the exact location of the tumor in relation to the headframe.
When this technique is used for biopsy or surgery, it guides the neurosurgeon in determining where to make a small hole in the skull to reach the tumor.
The state of the art in computer-assisted stereotaxis is the frameless technique, using a navigational wand. Without requiring a headframe, this technique improves surgical precision, allowing the neurosurgeon to more accurately locate the tumor while minimizing the amount of exploratory probing of delicate brain tissue.
Used in combination with radiation therapy, stereotaxis allows the radiation oncologist to more precisely direct the radiation to reach the tumor. This may decrease the adverse effects of radiation on healthy surrounding brain tissue.
In some patients stereotactic techniques are safer and may prevent potential complications associated with conventional procedures and generally result in shorter hospital stays.
A Helpful Resource
The American Brain Tumor Association provides information to patients and their families. Services offered include patient education publications, a newsletter and listings of brain tumor support groups.
To receive information, call 800/886-2282.
About Clinical Trials
You may receive treatment that is considered standard therapy based on its effectiveness in a number of patients in past studies. But, standard therapy is not effective in all patients, and some standard therapies have more side effects than desired. For these reasons, you may elect to enter a clinical trial of a new treatment.
Clinical trials are designed to find better ways to treat patients that are potentially more effective and/or have fewer side effects than standard treatments. Clinical trials are often recommended for patients with tumors considered unresectable (unable to be surgically removed due to their location) or otherwise untreatable, and for almost all children who have brain tumors.
"Children who are treated on clinical trials have the advantage of getting the best available therapy," according to the NCI. Two-thirds of children with brain tumors are treated as part of a clinical trial at some point in their illness, and many improvements in survival for children who have brain tumors are the result of clinical trials.
Where Do You Begin?
Measuring quality in ways that are useful to consumers is a new idea in health care. Because of that, it may not be possible to get complete information for each of these quality indicators. But the willingness of providers to give you as much information as possible is a good sign. It shows that they are dedicated to maintaining and improving their quality, responsive to patients, and confident of their capabilities.
If you or your child have any symptoms of a brain lesion, your family doctor may obtain a brain scan or refer you to a neurologist or neurosurgeon for evaluation. If the presence of a brain tumor is confirmed, ask for a referral to a brain tumor specialist and a hospital that offer a multidisciplinary approach and have extensive experience in diagnosing and treating this specific type of tumor. You also should look for a treatment center that offers the newest, most effective treatments, including stereotactic radiation therapy and stereotactic surgery, as well as clinical trials of experimental, potentially better treatments.
Ask the questions we suggest in the following pages. Make comparisons. Then make your decision. Be an informed consumer for yourself and your family.
Sidebar
Getting a Second Opinion
Getting the right treatment depends on a correct diagnosis. For that reason, if you or someone in your family are diagnosed with a brain tumor, you may want to seek a second opinion to confirm the diagnosis. You will want to make sure that the diagnosis is based on expert analysis conducted by a neuropathologist experienced in identifying different types of brain tumors and disease stages.
You may also want a second opinion to ensure that the treatment planned is appropriate and provides the best chance of effectiveness against this particular type of tumor.
How to Use Quality Indicators
How can you use these indicators to judge if one doctor or hospital is better for you than another? By combining information from more than one quality indicator, according to a report, "The Quality of Medical Care: Information for Consumers," produced by the U.S. Congress, Office of Technology Assessment.
According to the report, patients about to have surgery for a brain tumor can be confident if the hospital performs a high number of surgeries, has a low mortality (death) rate, and if the surgeon has extensive training and experience in state-of-the-art procedures.
On the other hand, the report states "...if a hospital has a high mortality rate and a low volume of procedures, the patient might wish to question the surgeon about that hospital and about alternatives, even if other hospitals require longer travel."
1. Credentials
Do the doctor and hospital measure up?
Credentials have been set by nationally recognized medical professional organizations to verify that doctors and hospitals meet certain standards in health care delivery.
Doctors:
Board certification, or the international equivalent, is a sign that doctors are highly trained in their fields. Doctors who specialize, such as neurologists and neurosurgeons, should be board certified in the specialty in which they are practicing. Each specialty has a national board that is responsible for setting standards doctors must meet in order to be certified. Doctors who are board certified in their specialties have completed the amount of training that the specialty board requires, have practiced for a specified number of years in that specialty and have passed a difficult examination in their specialty areas. Some excellent doctors are not board certified. Board certification, however, is generally a good indicator of competence and experience.
Hospitals:
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. The JCAHO decides whether a hospital gets, keeps or loses accreditation based on its meeting certain criteria for staffing, equipment and facility safety requirements. Although accreditation is voluntary, most hospitals go through the process. If the hospital that you are considering is not accredited, it is important to know why.
Hospitals that do measure up are often in the public spotlight for their medical advances and the quality of their care. Information about a hospital's reputation is widely available through the mass media, books such as "The Best Hospitals in America," the government and consumer groups.
Sidebar
For information about a hospital's status, call the Joint Commission on Accreditation of Health-care Organizations at
708/916-5800.
Are the neurologists and neurosurgeons board certified?
All Cleveland Clinic staff neurologists and neurosurgeons are board certified.
Are the neuro-oncologists board certified?
All Cleveland Clinic staff neuro-oncologists are board certified.
Are the interventional neuroradiologists board certified?
All Cleveland Clinic staff interventional neuroradiologists are board certified.
Are the radiation oncologists board certified?
All Cleveland Clinic staff radiation oncologists are board certified.
Are the pathologists board certified?
All Cleveland Clinic staff pathologists are board certified.
Is the hospital accredited by JCAHO?
Yes. The Cleveland Clinic has JCAHO accreditation.
Has the hospital been positively and consistently recognized for medical excellence and leadership?
Yes. The Cleveland Clinic is often named among the top medical centers in the country. Some of the publications that have recognized the Clinic for excellence include those mentioned in the box at left.
Board certification or its international equivalent became a requirement at the Cleveland Clinic in 1989 for doctors to receive medical full staff appointments.
Sidebar
One of America's Best
-U.S. News & World Report has named the Cleveland Clinic one of "America's Ten Best Hospitals" for the past five years (1990, 1991, 1992, 1993, 1994). The Cleveland Clinic was recognized for excellence in neurologic care in all five years.
-American Health, April 1993, named the Clinic among the top medical centers in the country.
-"The Best in Medicine: Where to Get the Finest Health Care For You and Your Family" (Crown, 1990) singled out the Cleveland Clinic for excellence.
2. Experience
Does practice make perfect?
In the case of complex medical and surgical care for brain tumors, the more experience the doctors and hospital have, the better the results usually will be.
Experience in treating brain tumors is important because the problem is so complex. Any treatment involving the central nervous system has the potential to cause serious complications such as paralysis or speech or memory deficits. The more experience the team members have, the greater their ability to prevent such complications. An experienced surgical neuro-oncologist who has handled many cases is prepared for the most difficult situations.
How many people with brain tumors are treated at the hospital each year?
In 1994, 413 people with brain tumors were treated at the Cleveland Clinic, making the Clinic the busiest brain tumor center in Northeast Ohio.
How many surgical procedures for brain tumors are performed at the hospital each year?
In 1994, Clinic surgeons performed 232 surgeries for brain tumors. On average, neurosurgeons across the country perform fewer than five brain tumor surgeries a year.
How many patients undergo radiation therapy for brain tumors each year?
At the Cleveland Clinic, 280 people with brain tumors received radiation therapy in 1994.
How long has the hospital been offering stereotactic radiosurgery for brain tumors?
Cleveland Clinic neurosurgeons, who were among the first in the country to treat brain tumors with stereotactic radiosurgery, have been performing this procedure since 1985.
3. Range of Services
What services are available?
Hospitals with a broad range of services can treat more complex medical conditions and better handle complications that may occur.
Range of specialty departments
A brain tumor may affect the functioning of many body systems, and some treatments can have a wide range of side effects. To add to the complexity of the situation, adult patients with brain tumors often have other medical problems as well, such as diabetes or heart disease. Therefore, immediate access to a full range of specialty departments within a facility is critical.
Range of diagnostic and treatment options
The diagnosis and treatment of brain tumors involve health care professionals from many disciplines working as a team. Diagnosis may require several different studies to adequately characterize the tumor. Treatment is typically a combination of therapies and may include promising new therapies being tested in clinical trials. For the best chance for a positive outcome, look for a medical center that offers the full spectrum of diagnostic and treatment options, both standard and experimental.
Rehabilitation
Rehabilitation is often an important part of treatment for brain tumors. Patients who experience temporary or permanent difficulties in speech, memory or motor skills as a result of a tumor require specialized therapy by speech, physical or occupational therapists with training and experience in the needs of brain tumor patients.
Is help available from a full-range of specialty departments?
The Cleveland Clinic's 600 physicians — all on staff full time — provide care in 100 specialties and subspecialties, including neurology, neurosurgery and rehabilitation medicine. All of these specialties including the Cleveland Clinic Children's Hospital are present in one facility, so multidisciplinary consultation, diagnosis and treatment are readily available.
Does the hospital offer a variety of options for diagnosing and treating brain tumors?
The Clinic offers a full range of options which include those listed on the left.
Does the hospital provide rehabilitation services for brain tumor patients?
The Cleveland Clinic offers comprehensive, individualized rehabilitation services for brain tumor patients. These include vocational rehabilitation, physical therapy, occupational therapy, psychology, and sexual counseling. Patients who require ongoing rehabilitation after discharge are scheduled for outpatient follow-up or home visits.
Sidebar
Options for Diagnosing and Treating Brain Tumors
Computerized axial tomography
Digital subtraction angiography
Magnetic resonance imaging
Magnetic resonance angiography
Magnetic resonance spectroscopy
Positron emission tomography
Single photon electron computerized tomography
Cerebral angiography
Biopsy and stereotactic biopsy
Pathology
State-of-the-art neurosurgical techniques, including stereotaxy
Radiation therapy (conventional external)
Stereotactic radiosurgery (photon knife)
Hypo- and hyperfractionated radiotherapy
Brachytherapy (internal radiation)
Chemotherapy using the newest agents
Immunotherapy with biologic response modifiers
Rehabilitation services including physical, occupational and speech therapy
Social work
Support groups for people with brain tumors
Nutritional support services
Pharmacy services
Palliative care
Home hospice
4. Participation in Research and Education
What type of hospital is it?
Selecting a hospital that combines patient care with research and education offers many advantages.
Ideally, the individuals engaged in patient care, research and teaching are organized around a given disease or class of patients, facilitating the sharing of knowledge, research and clinical findings. This results in an important inter-change of ideas between laboratory researchers and clinical practitioners, so that what happens in the laboratory influences what happens in clinical practice and vice versa. Ultimately, this approach permits the most rapid transfer of basic scientific knowledge from the laboratory to care delivery at the patient's bedside.
Physicians who are responsible for teaching residents and medical students must stay up-to-date on the newest treatments and technology so that they can effectively instruct their students. For patients in a teaching hospital, this means the opportunity to participate in clinical trials that examine the effectiveness of the latest investigative treatment strategies. In this way, patients can receive promising new therapies before they are available in the general community.
Choosing a teaching hospital for your care may offer other advantages as well. Private, not-for-profit teaching hospitals had lower mortality rates than other types of hospitals, according to a study in the December 1989 issue of the New England Journal of Medicine.
Is the hospital associated with a teaching program?
Yes. Incorporated in 1935, The Cleveland Clinic Educational Foundation sponsors one of the nation's largest physician postgraduate training programs. The Cleveland Clinic is affiliated with the medical school at The Ohio State University.
Does the hospital have fully accredited residency training programs in specialties related to brain tumors?
The Cleveland Clinic has fully accredited residency training programs in neurosurgery, neurology, radiation oncology and radiology, as well as fellowship training programs in hematology and medical oncology, radiation oncology, neuro-oncology and palliative care.
Does the hospital conduct basic research or clinical trials related to brain tumors?
The Cleveland Clinic maintains active basic and clinical research programs in brain tumors and, as a result, offers many investigational therapies that are not widely available. Recent and ongoing research includes:
-Radiation implants for newly diagnosed tumors
-Study of the causes of primary brain tumors
-Identification of genetic defects in primary brain tumors and potential gene therapies
-Experimental chemotherapeutic agents administered intravenously or intra-arterially to shrink recurrent glioblastoma (a specific type of brain tumor)
-High-dose chemotherapy and bone marrow rescue in treatment of certain tumors
-Pre-radiation chemotherapy
-Tumor embolization
-Experimental chemotherapy in unresectable pediatric brain tumors
-Noninvasive measures for identifying early response to growth modifiers
-Noninvasive techniques to detect tumor type and grade
-Use of the immune system and growth modifiers to enhance cell death
Sidebar
Future Research Directions
Cleveland Clinic scientists and physicians are exploring many new areas in brain tumor treatment. Studies planned to begin in the near future include:
-robotic radiotherapy
-gene therapy
-adaptive immunotherapy in primary brain tumors
-advanced stereotactic radiosurgery
5. Patient Satisfaction
Is everybody happy?
If you ask one person about his or her experience with a doctor or hospital, you get one person's point of view. Patient satisfaction surveys allow you to judge quality based on the experience of many previous patients. This provides you with a more objective measure to use.
Most hospitals routinely use surveys to learn if patients are satisfied with their medical experiences. The hospital can use these results to improve its services.
Patient satisfaction often reflects the personal side of care. Surveys ask questions such as, How willing are the doctors and nurses to listen? Do they answer questions and explain treatments? How much time does the doctor spend with the patient? Is the hospital clean? Is the food good?
Patient satisfaction information can predict what your experience in a particular hospital is likely to be.
How do hospitalized patients rate the quality of care they receive at this facility?
94% of Cleveland Clinic patients hospitalized for complex open-skull (craniotomy) procedures such as those used to remove brain tumors rated the quality of their care as good to excellent.
93% said they probably or definitely would return to the Cleveland Clinic for their care.
Would patients treated at this hospital recommend it to their family and friends?
97% of these patients said they definitely or probably would recommend the Cleveland Clinic to others.
How satisfied are outpatients with the overall medical care they receive from the doctors, nurses and other health care providers at this facility?
96% said they were either very satisfied or satisfied with their experience.
97% said they would definitely or probably return if they needed further medical care.
Is there a program to help patients and their families with the difficulties that may arise during a hospital stay?
Cleveland Clinic patients may call an ombudsman — another name for a patient-relations representative — if they have concerns about their care.
Patients in the Cleveland Clinic hospital may dial a 24-hour Helpline from their hospital rooms if they have any problems, questions, suggestions or concerns related to service.
6. Outcome Indicators
What are the risks?
Many outcome indicators can be used to measure the success of treatment and the risks associated with it. The indicators used depend on the treatment or procedure. For procedures used to treat life-threatening conditions, the mortality (death) rate associated with a procedure is often the most important measure of your risk and a sensitive measure of quality.
Try to compare mortality rates for patients most like yourself because each patient's characteristics (such as age, general physical condition, stage at which the brain tumor is diagnosed and the type of tumor) affect outcome. Comparing apples with apples is important so that you know what your risks really are. If a doctor or hospital cannot give you these rates or is reluctant to give information, look at alternatives.
People who are successfully treated for brain tumors have fewer problems and therefore are discharged from the hospital earlier. This means a hospital's average length of stay for patients who undergo neurosurgery or other inpatient treatment for a brain tumor is an appropriate measure of quality.
On the facing page, we provide mortality rates and length of stay for patients who have received brain tumor treatment at the Cleveland Clinic.
What is the hospital's mortality rate for patients undergoing treatment for a brain tumor?
In 1992, the most recent year for which national comparable data is available, mortality for Cleveland Clinic patients was 1.26% (The 1992 data was based on 238 patients treated for brain tumors at the Cleveland Clinic).
Nationally, mortality was 5.47%, (based on 1,426 patients treated for brain tumors in 1992).
What is the hospital's average length of stay for brain tumor patients?
In 1992, the most recent year for which comparable data is available, the average length of stay for Cleveland Clinic patients undergoing treatment for a brain tumor was 7.47 days.
The national average for the same year was 9.48 days.*
Charts: Mortality & Length of Stay
comparability, it does not include patients with coverage under Medicare or Medicaid. National comparative data is from the MarketScan database which collects this information from more than 100 health insurance companies.
Sidebar
Research into Quality of Life Outcomes
The Cleveland Clinic is beginning to measure and determine the health status and quality of life patients experience following their treatment here. Returning to work, being able to perform the usual activities of daily living and being free from pain are some of these important indicators of successful care.
We asked approximately 250 patients with a variety of medical conditions to tell us their health status before, during and after treatment.
More than 80% responded.
All of the patients who responded (100%) thought their ability to function and quality of life generally improved following their care here.
Approximately 70% experienced substantial improvement in physical function, pain relief and energy.
Pioneering Work in Treatment for Brain Tumors
The Cleveland Clinic Foundation is recognized for its comprehensive commitment to diagnosing and treating malignant and non-malignant brain tumors in adults and children. Clinic doctors and scientists have been responsible for a number of innovations in brain tumor diagnosis and treatment, particularly in computer-assisted stereotactic techniques. Their contributions include:
-Pioneering work in stereotactic diagnosis, radiation therapy and surgery that improves precision and safety
-Development of the sonic wand for use in stereotactic neurosurgery
-Development of stereotactic techniques for tumors not resectable by conventional surgery
-Development and application of chemotherapy for patients with brain metastases from systemic cancer
-Pioneering work in intra-arterial chemotherapy for malignant tumors
-Research in cell growth modifiers in malignant gliomas including tumor necrosis factor and protein kinase-C inhibitors
-Intraventricular administration of investigative chemotherapeutic agents in pediatric brain tumors
-Membership in major national brain tumor study groups, including the Brain Tumor Cooperative Group, the Southwest Oncology Group, the Neurofibromatosis Consortium and the Children's Cancer Group
Sidebars
For An Appointment
If you would like to make an appointment with a Cleveland Clinic brain tumor specialist, please call the Brain Tumor Center at one of the numbers listed below:
216/445-8504
(in Cleveland)
800/CCF-CARE (223-2273), Ext. 58504
(toll-free outside Cleveland)
For More Information
If you would like to receive any of the other guides in our series "How to Choose a Doctor and Hospital for Your Treatment," please call one of the numbers below:
216/444-8919
(in Cleveland)
800/545-7718
(toll-free outside Cleveland)
Cleveland Clinic Florida
Cleveland Clinic Florida is drawing upon the Cleveland Clinic's experience and expertise to begin developing corresponding innovative programs in brain tumor treatment. For more information, call Cleveland Clinic Florida at 800/359-5101.
Reprinted with permission by: Med Help International
