Community Center Collaboration: How to Ensure All Glioma Patients Get Access to the Best Care

Gliomas and other brain malignancies pose unique challenges for healthcare providers, particularly those working in brain centers that do not see a high volume of patients. Because these centers may not treat nearly as many patients as academic institutions, they may lack resources and expertise in certain areas.

However, the growing complexity of brain tumor management, including advancements in molecular diagnostics and treatment modalities, makes it critical for all providers to stay informed and equipped.

Understanding the Gaps in Low-Volume Centers

Low-volume centers often face challenges such as lack of access to the latest treatment tools. A significant gap is the limited availability of molecular testing, which is now essential for accurate glioma classification and personalized treatment planning. Next-generation sequencing (NGS) to identify mutations such as IDH, 1p/19q co-deletions, and MGMT promoter methylation may not be routine in community settings, leading to delays in diagnosis or suboptimal treatment decisions.

Importantly, many low-volume centers lack multidisciplinary neuro-oncology teams, which are critical for coordinating complex care. Without dedicated neurosurgeons, neuro-oncologists, and radiation oncologists working collaboratively, patients may not receive comprehensive treatment planning. However, one way to close this gap is for doctors working at community hospitals to utilize resources like virtual tumor boards.

“At facilities that are lower volume for gliomas, I really encourage them to utilize the internet, utilize the tools that we have,” Dr. Erin Dunbar, a neuro-oncologist at Piedmont Healthcare in Atlanta, tells SurvivorNet Connect. “There are virtual tumor boards.”

Some of the virtual tumor boards Dr. Dunbar mentioned include those of the Society of Neuro-Oncology and the National Institutes of Health (NIH).

“…We’ve never had more ability to be connected to make great decisions,” she adds.

The Value of Full Resection & Neurosurgical Expertise

From a neurosurgical perspective, maximizing the extent of tumor resection is critical in glioma management, as survival often correlates with the degree of tumor removal. In low-volume centers, neurosurgeons may lack the experience or tools necessary for more extensive resections, as many community neurosurgeons primarily focus on spinal procedures. For example, a neurosurgeon in a smaller town may only encounter one or two glioma cases per year.

Advances in surgical techniques, such as intraoperative mapping and awake craniotomy, have significantly improved the ability to remove gliomas safely, even in eloquent areas of the brain. For tumors deemed unresectable at low-volume centers, seeking a second opinion from a high-volume center may open new possibilities for more aggressive surgery.

Additionally, innovative approaches like laser interstitial thermal therapy (LITT) can be considered for otherwise inaccessible tumors. Encouraging patients to seek second opinions when surgery is initially ruled out is critical to ensuring they receive the best possible care.

That said, community hospitals and larger cancer centers can often work together to ensure a patient gets the best care possible.

“We love working with community physicians and we want to partner with these people,” Dr. Katherine Peters, a neuro-oncologist at Duke Health, tells SurvivorNet Connect. “So I think we can share patients across sites. We share patients across sites all the time. They can see me once every three months or every six months or even yearly or at the time of progression. I can help sort of guide or direct that care, while the local oncologists can see them much more frequently in order to take care of the day-to-day things.”

Practical Guidelines for Glioma Management

Key steps to streamline the workup and management of gliomas include:

1. Imaging: MRI with contrast remains the gold standard for evaluating brain masses. Providers should be trained to recognize features suggestive of gliomas, such as enhancement, infiltration, and mass effect.
2. Biopsy and Molecular Testing: Early referral for biopsy or resection is critical to obtain a definitive diagnosis. Tissue should be sent for molecular testing to identify IDH mutations, 1p/19q co-deletions, and MGMT methylation. Collaboration with regional labs or academic centers can help ensure these tests are performed efficiently.
3. Surgical Planning: If surgery is planned, providers must weigh the neurologic risks of resection against oncologic benefits. Tools like functional MRI and intraoperative mapping should be used when available to maximize resection while preserving function.
4. Referral to High-Volume Centers: As Dr. Peters highlights, community providers should not hesitate to refer patients to high-volume centers for complex cases. These centers often have access to advanced surgical techniques and advanced radiation treatment modalities, such as proton beam therapy, which may offer advantages in select cases.

Promoting Multidisciplinary Collaboration

While low-volume centers may not have access to formal multidisciplinary clinics, fostering collaboration among local specialists can replicate this model. For example, joint case reviews among neurosurgeons, medical oncologists, and radiation oncologists can improve care coordination. As previously mentioned, telemedicine-based tumor boards provide an effective way for community providers to discuss complex cases without needing extensive infrastructure, and are much more convenient to be apart of.

Collaboration with academic centers can also ensure that patients benefit from access to cutting-edge treatments when appropriate. Community providers can also partner with academic centers for second opinions, access to clinical trials, and guidance on advanced imaging or treatment planning.

Managing Referrals & Maintaining Patient Trust

Referrals to academic centers are often necessary for specialized surgical procedures, advanced diagnostics, or participation in clinical trials. However, providers at low-volume centers may hesitate to refer patients due to concerns about losing them entirely to the academic institution.

A shared-care model can address these concerns. In this approach, patients receive specialized care at the academic center but return to their community provider for ongoing management, such as chemotherapy, follow-up imaging, and supportive care. Academic centers can support this model by providing detailed treatment summaries and maintaining open communication with referring providers.

Educating patients about the collaborative nature of their care can also help build trust. 

Expanding Access to Molecular Testing

Molecular testing is foundational for modern glioma management, but access remains a challenge for many low-volume centers. To expand access, community providers should:

-Partner with academic centers or commercial labs to establish streamlined workflows for molecular diagnostics
-Advocate for insurance coverage and educate patients on the importance of testing to reduce financial barriers
-Incorporate training on molecular testing into continuing education programs to ensure providers stay informed about the latest advances

Supporting Education Through Ongoing Training

Engaging in education tailored to community providers is essential to remain up-to-date with advancements in glioma management. Workshops, webinars, and on-site training sessions can cover topics such as:

-Interpreting molecular test results and incorporating them into treatment planning
-Managing side effects of chemotherapy, radiation, and targeted therapies
-Recognizing when to refer patients for specialized care or clinical trials