Procedures and Well-Care Clinics in Neuro-Oncology

Abstract Advanced practice provider (APP)-led procedural and well-care clinics in neuro-oncology are underutilized even though these clinics provide increased APP autonomy and leadership opportunities along with improved standardization of patient care. Common procedures in neuro-oncology include lumbar puncture and Ommaya reservoir access (for cerebral spinal fluid collection or intrathecal chemotherapy administration), ventriculoperitoneal shunt and vagal nerve stimulator interrogation and reprogramming. Well-care clinics typically involve non-acute patient assessments for those on chemotherapy or active surveillance, or they serve those with general complaints and cancer-related neurologic symptoms. These APP-led clinics also allow for increased physician patient-facing time in the non-procedural setting and potentially more time for physician’s administrative duties. Providers in these clinics must be trained to readily identify common therapeutic or procedural side effects, absolute and relative contraindications to therapies, and other common non-neurologic conditions in cancer patients that could result in poorer outcomes. They provide opportunities to escalate or de-escalate care, implement further diagnostic testing, refer to subspecialties, and facilitate communication between all providers involved in patient care. Assessments in these clinics offer opportunities for APPs to build patient and caregiver rapport as they gather important information related to symptom management, medication tolerance, and social work and respite needs. The overarching objective of these clinics is to promote quality survival. This chapter discusses specific clinical procedures and the role and value of APPs in neuro-oncology clinics.