The content and efficacy of conventional methods of follow-up in neuro-oncology: the need for new strategies.

In a combined retrospective and prospective analysis, we examined the content and outcome of conventional follow-up of patients with malignant brain tumours. Most consultations consisted of discussion and advice from the clinic doctor or nurse in certain well defined areas. Clinical examination, including neurological examination, was ineffective at detecting tumour recurrence. All recurrences presented with clinical features noted by the patient or by carers prior to the clinic attendance. The analysis of content and outcome of conventional outpatient consultation suggests that patients with high grade gliomas might be better served by methods of follow-up other than routine hospital attendance. There is a need to develop new follow-up strategies which are patient orientated and which address issues specific to the disease type other than tumour recurrence alone.