'Standard of Care Plus': Thinking Outside the Box

  • Standard of care “plus” involves “thinking outside of the box … but you’d also include standard of care as your scaffold,” Dr. Katherine Peters, a neurologist at Duke Health, tells SurvivorNet Connect.
  • This is a broad term that could refer to any number approaches — from sequencing tumors to look for appropriate targeted therapies to using integrative medicine to providing social support to patients and their families.

Standard of care “plus” is an approach to treating glioma that considers and likely implements the standard of care, but also considers additional therapies that could help the patient and don’t fall under that standard umbrella.

“Standard of care plus is really going that one step beyond — can you find something that is actionable? It means that you’re thinking outside of the box … but you’d also include standard of care as your scaffold,” Dr. Katherine Peters, a neurologist at Duke Health, tells SurvivorNet Connect.

Dr. Alexandra Miller, Director of the Neuro-Oncology Division at NYU Langone Health, gave an example of an additional therapy she uses in certain situations. “I always include the standard of care or at least discuss the standard of care with the patient and make sure they agree with that,” she explains. “Standard of care plus can mean a huge range of things. One thing that I often am adding on now is Prozac to the regimen. There is provocative, pre-clinical data that it may have a tumor directed benefit — and I think that for many of my patients, it has a lifestyle benefit as they’re coping with this.”

Dr. Ganesh Rao, Chair of Neurosurgery at Baylor College of Medicine in Houston adds that patients can have their tumor sequenced, which may open the door to other treatments beyond what is considered standard of care. “All those little things at academic centers or high-volume centers that have multi-disciplinary care [where] everyone on the panel has access to that, that really helps the patients get access to other treatments,” beyond the standard, Dr. Rao explains.

Standard of care plus may go beyond traditional cancer therapies to ensure patients are taken care of in other ways — like caring for their mental health, for example.

“It might be a medicine or a non-medicine, it might be integrative medicine, it might be mind-body wellness, it might be additional financial assistance and social support for the family and their loved ones,” Dr. Erin Dunbar, a neuro-oncologist at Piedmont Healthcare in Atlanta, explains. “We’re always looking for … those additional things we can add in to their care.”