PhD in Medicine: Developing a screening tool for the late effects of treatment for brain cancers

Introduction: Brain tumour patients may experience delayed effects of radiotherapy or chemoradiotherapy. Referral for more detailed assessment and intervention can reduce symptom burden, dependency and carer distress. This PhD studentship will focus on the development of a simple screening tool for neurocognitive effects of brain irradiation or combined chemoradiotherapy. The study will focus on those with high grade glioma but will also consider those receiving high dose brain radiotherapy for brain metastases.
The Marie Curie Research Centre has previously developed Alert B, which is a simple, user-friendly screening tool for severe gastrointestinal problems as a late effect of radiotherapy. The tool is now included in national radiotherapy guidelines and is currently being tested on an existing patient electronic platform, with the view to implementation across NHS England. The proposed screening tool will join Alert B as the format for future tools and join a national programme of implementation studies.
Background: High-grade primary malignant glioma is an aggressive form of brain tumour with significant symptom burden. It is also associated with a range of physical, mental and social side effects related to treatment through chemo-radiotherapy. Despite the high prevalence of such side effects, there are no agreed routine assessment or referral criteria for neuro-rehabilitation and other supportive interventions in the UK. Yet there is an emergence of pharmacological and psycho-behavioural interventions. There is a need to better screen patients for delayed effects of radiotherapy or chemo-radiotherapy, using easily administered screening tools in non-specialist settings to trigger referral for specialist intervention. This is particularly important as many patients are reside and are cared for away from specialized neurooncology settings.
Aim: The aim of this studentship is to develop a readily accessible, clinically applicable screening tool for the neurocognitive effects of brain irradiation or combined chemo-radiotherapy, in order to improve the supportive care of patients suffering from the later effects of cancer and reduce carer distress.
Methods: The studentship will have three distinct methodological phases. Firstly, a comprehensive systematic review will be carried out, to explore the treatment modalities available to patients with high-grade glioma, and to establish which screening tools are currently in use to test for evidence of side effects, together with the kinds of treatments available for these. Consensus on the results of the review will then be gathered, from an expert panel of patients, carers, public contributors, researchers and health care professionals. This will aim to highlight which symptoms are important, and where effective treatments would be available to patients/carers. Once these items have been finalised, the option of implementing directly, or being used to develop trigger questions will be explored. If trigger questions are developed, these will be tested on patients and carers. Throughout the project, we will also be working towards the implementation of the tool at a national level via an online patient platform.