Brain Tumor Treatment: When Do Neuro-Oncologists Switch Strategies?

Keck Medicine of USC neuro-oncologist Frances Chow, MD, discusses factors that shape treatment decisions for brain tumor patients.

Frances Elaine Chow, MD, is a neuro-oncologist with the USC Brain Tumor Center, part of the USC Norris Comprehensive Cancer Center and Keck Medicine of USC, who specializes in treating brain and spine tumors.

To choose treatments, we need to understand guidelines, biomarkers and each patient’s unique needs.

All physicians rely on evidence-based medicine. In neuro-oncology, this means keeping on top of the latest scientific evidence — integrated with clinical expertise in patient-centered care — regarding new symptoms, abnormal lab values or growth of the tumor. These indications are foundational to our decision to change the treatment approach.

Yet I have also found that understanding the unique needs of each patient plays a key role in how we implement the science. In other words, the scientific and personal aspects of medicine are not contradictory, but complementary. At times, they are interdependent.

This means I’m always striving for balance between the benefit the patient is getting from these therapies and the impact these therapies have on their quality of life.

Listening is key to understanding patient priorities.

The goals and priorities of brain tumor patients are deeply personal and widely varied. It is crucial to truly listen to each patient’s concerns. I also strive to maintain a close relationship with my patients, where communication flows easily, so they can feel safe sharing if their symptoms or wishes have changed.

When it’s my turn to communicate, my role is to lay all the science out on the table, including the latest advances, and to help the patient and their family navigate their options. From there, decision making often flows smoothly. On the rare occasions when it doesn’t, it helps to have a set of strategies in place to ensure the patient’s well-being is put first.

What happens when doctor and patient disagree?

There are times when a patient will ask for a treatment that has not been scientifically vetted or will not serve in their best interest. When this happens, I make a point to sit with them and explore where this request is coming from. Very often, it is the result of their very real and legitimate apprehensions about the cancer journey before them.

Once this question is answered, we as physicians can share our experiences, as well as publications, recent studies and updated information, that have given us the evidence we rely on to care for our patients. This background often alleviates a patient’s fears.

Once these perspectives are shared both ways, finding a good middle ground becomes much easier.

What role do external factors play in shaping a patient’s treatment plan?

Eradicating brain tumors and mitigating the harm they do on a broad scale is a team effort. Because we have such limited therapies for brain tumor patients, we’re always looking for new advances and methodologies from our peer physicians and researchers.

To me, each medical conference I attend brings hope that I might return to Los Angeles with a powerful new insight or scientific information that could help my patients. It also serves as an opportunity to collaborate with colleagues, including those from different specialties, to learn how to best implement the most innovative therapies available.

Compassion-informed care is key.

It would be disingenuous to ignore the role that our empathy — or at least our sense of responsibility — plays in the process of determining treatment plans. While I am driven to prolong the patient’s life, I also want to make sure they have a good life.

We as physicians are on this journey with each patient. And no matter how many patients I encounter, I still remember each one. It shocks me when, months or years after treating a patient, I run into a family member, and they ask if I remember them.

Of course, physicians remember.

We remember former patients as if they were here yesterday. In the end, they leave an imprint on us, just as we hope to make a positive impact on their lives. This level of genuine care, and the relationship it allows us to build with the patient, is essential to the mutual trust required for us to develop the treatment approach that’s best for them.

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