Brain Tumor/Neuro-Oncology Clinic at the LAC+USC Medical Center

Being diagnosed with a brain tumor is a life-changing and potentially harrowing experience that greatly affects patients and families alike. The treatment of brain tumors is inherently complex, and requires streamlined management by a variety of healthcare practitioners (physicians, nurses, rehabilitation specialists, social workers, hospice workers, etc.) Patients diagnosed with brain tumors are often young and otherwise healthy and productive members of society that may suddenly transition to requiring frequent and chronic care, resulting in reduced workforce participation and mandating a variety of additional support services. The physical, financial, and emotional burdens on patients diagnosed with brain cancer, as well as their families, are further exacerbated when they are constrained by complex socioeconomic factors. Numerous studies have identified significant healthcare disparities with regard to access to care and treatment outcomes in brain tumor patients with lower socioeconomic or minority status, less education, and no insurance (Curry WT, Neurosurgery, 2010 and Mukherjee D, J Clin Neurosci, 2013). For brain tumor patients with such disadvantages, following complex treatment regimens (such as chemotherapy, daily radiation therapy, or clinical trials) and navigating a complex healthcare system composed of fragmented clinics and/or hospitals or non-native languages can be especially disheartening. These factors, coupled with the neurological deficits often caused by these tumors (such as paralysis or language/memory deficits) makes adherence to complex medical regimens even more of a struggle. It is therefore no surprise that many patients with socioeconomic disadvantages receiving brain tumor care have a difficult time making all their appointments (often several per week), or adhering to physician recommendations, sometimes resulting in delays in time-sensitive care. The LA County+USC Medical Center is the largest public hospital in Southern California, serving as a safety net institution and providing quality healthcare to millions of underserved and indigent Angelenos and other U.S. and world citizens. In January 2013, a group of Norris Comprehensive Cancer Center and Keck School of Medicine of USC physicians decided to form a multidisciplinary Brain Tumor/ Neuro-Oncology Clinic at LAC+USC in an attempt to streamline care for patients with complex primary brain tumors being treated at all LA County facilities. The weekly LAC+USC Brain Tumor Clinic staffed by these physicians receives patient referrals from any LA County-DHS sites AND OTHER LA HOSPITALS, thus serving as the ONLY centralized multidisciplinary Neuro-Oncology clinic for LA county residents. Patients have access to neurologists, neuro-oncologists, neurosurgeons, and radiation-oncologists during the SAME clinic visit, allowing the panel of physicians to discuss best-practice treatment options as a team, rather than fragmenting this care over several visits and potentially weeks or months. Furthermore, the clinic allows ALL patients to access the same therapeutic clinical trials as first-rate private academic institutions and cancer centers, which is a factor that has independently been associated with prolonged survival in patients with brain cancer (Shahar T, J Clin Neurosci, 2012). Although the Brain Tumor Clinic at LAC+USC was designed to accommodate a maximum of 12 patients per day, it is already overbooked to 15-18 patients per clinic for the next 3 months, demonstrating the dire need for this integral service in LA County. Our primary aim is to develop a world-class multi-disciplinary Brain Tumor/Neuro-Oncology Center of Excellence that will provide all LA County patients, regardless of insurance status, race, or education level with the same access to quality care for years to come. The development of a formal program at LAC+USC will ensure that this service is centralized at the County’s primary safety-net institution for decades. Support from the LA2050 grant will be used to develop a LA County Neuro-Oncology Center of Excellence, support a clinical nursing navigator/coordinator, manage a prospective patient database, create a program website and referral system, and provide seed money for researching brain tumor genomics and healthcare disparities in patients with brain tumors. By 2050, the potential for healthcare delivery in complex medical problems such as brain tumors to become even more disparate is a sad but sobering reality. Most indigent LA County patients with brain tumors do not have the luxury of visiting several practitioners or “shopping around” for their care. The potential to establish a Brain Tumor Center of Excellence embedded in our County’s largest public medical center is likely to at least partially offset this disparity, and help ensure that all patients with brain tumors in LA have access to the same basic care, clinical trials, and rapidly-evolving therapies.