The Essential Role of Collaboration in Neuro-oncology

Optimal patient management often requires participation of experts from various disciplines, and this is of particular importance when caring for patients with malignancies of the central nervous system. The establishment of a diagnosis stems from collaboration among radiology, neurology and molecular pathology — often relying on sample acquisition from colleagues in neurological surgery (including spinal fluid or biopsy of tumor tissue). Subsequent therapeutic planning further depends upon coordination among specialists, requiring multi-modal approaches that include radiation, chemotherapies and surgical resection. The sequencing of treatments will need to be discussed and adapted to the molecular tumor profile, available treatment options and individual patient condition. Last but not least, cancer patients have specific needs in nursing, rehabilitation and social work that must be coordinated.¹ Regular (at least weekly) cross-specialty tumor boards are an effective instrument to allow for interdisciplinary exchange, efficient communication and planning between teams,^2-4 as well as quality control. Indeed, previous studies suggest their use may be associated with improved patient outcomes and satisfaction.^5,6 The integration of molecular, radiographic and pathological data in these discussions is used to guide insightful therapeutic planning, including enrollment in appropriate clinical trials as well as thoughtful monitoring in post-operative patients.

In a parallel fashion, interdisciplinary collaboration is a key factor driving oncological research and translational advancements. The traditional physician scientist model, which relies on independent investigators focusing on discrete research interests, is inadequate to address many of the complex questions that challenge contemporary neuro-oncology. Recent advancements in glioblastoma (GBM) immunotherapy offer an illustrative example, whereby multi-lab consortiums have drawn upon diverse expertise to tackle biological impediments to therapeutic advancement.⁷ The molecular lability and rapid adaptation of GBM to standard oncology treatments has prompted the need for novel, multi-faceted regimens that require flexibility and agility from treating physicians. The unique contributions and perspectives of cell biologists, medicinal chemists, pharmacists and bioinformaticians have anchored the efforts of clinicians, epidemiologists and statisticians in development and validation of innovative therapeutic approaches, often culminating in clinical trials. Early and close collaboration among groups is essential to facilitate efficient longitudinal project planning and often lays the groundwork for future projects as back-end translational data is collected and processed.

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Collaborative and multidisciplinary environments will furthermore enhance the training of residents and other students pursuing careers in neuro-oncology. Exposure to the methods and perspectives of basic and clinical scientists provides critical context in understanding translational advancements; most residency programs in neurosurgery and neurology include protected research time for this purpose. Optimal training environments may include experiences in basic bench research, which provides enhanced understanding of the biomedical pipeline that drives innovation in diagnostic and therapeutic advancements. In turn, residents offer a valuable clinical perspective to basic scientists who have less direct exposure to patients and disease processes. Multidisciplinary lab meetings that include both medical and scientific trainees create a dynamic exchange of ideas, optimizing the creative potential of such gatherings, as well as educational value of protected time. The relationships established during these periods often form the nidus of productive early-career collaborations, facilitating key feedback loops between physicians and scientists to drive clinical innovation and therapeutic advances.