Brain Tumours
Adult

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Emergency Referrals

Useful Management Information

Refer patients with suspected primary Brain tumours through local neurosurgical pathway for further investigation and management
Often patients present acutely or sub-acutely with neurological symptoms and it may be more appropriate for these patients to be evaluated through the Emergency Department and then as an inpatient for urgent management of symptoms during the diagnostic process
Many patients presenting with symptomatic brain lesions may have metastatic disease from an alternative primary site and evaluation for a primary site is necessary. In cases where the patient is significantly symptomatic of their brain disease it may be more appropriate for these patients to be evaluated through the Emergency Department and then as an inpatient for urgent management of symptoms during the diagnostic process
Depending on the histological and molecular diagnosis, treatment options vary for different primary brain tumours, and patients’ cases are discussed through a multidisciplinary team meeting
Histology (biopsy or surgical specimen) should include molecular testing for appropriate WHO classification of the patient’s tumour
For women and men who have not completed their family, fertility preservation needs to be discussed
For patients with incurable (metastatic or recurrent) cancer consider the following:
documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the Women's and men's prognosis and their understanding of their prognosis
whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
specific patient goals and values that may impact on treatment choices
whether the patient has been referred to a palliative or supportive care service

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Patients with new onset of symptoms and new findings on imaging of a suspected brain tumour should be referred to the local emergency department for urgent control of symptoms and evaluation Patients without symptoms and finding of suspected brain tumours should be referred to the Neurosurgical team for evaluation and further investigation. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input. In some cases, new findings of brain tumours may represent metastatic disease from an alternative primary site and urgent evaluation with imaging of the chest, abdomen and pelvis may be also indicated Monitor neurological function; rapid progress or symptoms such as headache suspicious for raised intracranial pressure i.e. morning headache, vomiting and papilledema and/or associated neurological features i.e. new onset seizures, cognitive, behavioural or personality changes, neurological deficits warrant urgent referral to the Emergency Department Pituitary tumours should be referred concurrently to the Neurosurgical and Endocrinology teams Acoustic neuroma/vestibular schwannoma should be referred concurrently to the Neurosurgical and Ear, Nose and Throat / Otology teams Adjuvant treatment after surgery for primary brain tumour diagnosis (either biopsy or debulking surgery). Note in this instance usually the patient is referred after MDT by the Neurosurgeon Patients with prior treatment for primary brain tumours under a Medical Oncologist with change in symptoms / progression of symptoms for evaluation of recurrence or progression
Category 2 (appointment within 90 calendar days)	Transfer of care from another health service
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Detailed history of present signs and symptoms
Past medical history/pertinent social history
Current medications and allergies
Histology report
FBC results
U&E results
LFT results
LDH results
CT and / or MR Brain

Additional Referral Information

Other available imaging including CT, CAP, or PET report if available

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Not Available

Internal Referrals

Medical Oncology (E-Blueslips)

Fax

(07) 5687 4497

Post

Cancer Referral Centre,
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 2708

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Marcin Dzienis

Medical Director Radiation Oncology (ICON Cancer Care)

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Brain TumoursAdult