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Neuro-Oncology Clinic Rotation - Schedule


Mon

Tues

Weds

Thurs

Fri

Weekends

AMContinuity clinicOFFConferencesCognitiveNeuro-Onc (Leung)No clinical duties*
PMNeuro-Onc (Junck)CognitiveNeuro-Onc (Junck, Umemura)CognitiveCognitive (virtual)No clinical duties*

* May be scheduled for random nights or jeopardy

  • Clinic is in room 1215 at the Cancer Center (1st Floor, middle of the building) most days
  • On Wed PMs when we meet in room 1354 (1st Floor, around the corner from 1215).


Learning objectives (note: may need updating since last emailed in 2019)

  1. Reading materials
    • See list of key articles in neuro-oncology, with comments about the articles. Dr. Umemura suggests you at least read the abstracts.
    • Articles PDFs attached in 3 separate batches.
    • Other good resources are UpToDate on key topics (e.g. GBM, low grade glioma, mets, lepto etc), other textbooks (e.g. Neurologic Complications of Cancer by Posner & Deangelis), Continuum (a neuro quarterly publications, articles can be downloaded via institutional Ovid access).


Logistics

Our team members

  • Jessica Eikmeier, PA
  • Brinton Robison, PA
  • Sandra Gillipsie, RN (most of Leung & Umemura pt)
  • Rose Buckley, RN (most of Junck pt and some Umemura pt)
  • Lori Pimlott - new patient intake / coordinator, she's offsite so you will not meet her but may correspond via email
  • Donyel Crisp - for any record scanning request etc (Polina Abel for disability papers)
  • Useful MiChart pool addresses
    • P CC NEU ONC ADMN SUP – clerical / scheduling matters
    • P CC NEU ONC CLN SUP – RNs
      • P CC NEU ONC RECORDS – established patient record / imaging request (for new patient, Lori Pimlott), disability papers etc

Clinic prep

  • We try to assign patients ahead of time, but that can get changed depending on clinic flow. We’ve been told this can feel a bit chaotic, when you’ve prepared to see someone but not the other. Unfortunately sticking to the plan rigidly is not feasible with brain tumor patients and we need to be flexible. This won’t usually happen for new patients, but can happen for returns.
  • I recommend skimming over patients information (last note, recent phone notes etc) on patients who weren’t pre-assigned to you ahead of time so you don’t feel so thrown off. We’ll also brief you prior to you seeing the patient.
  1. Notes
    • .NONPNOTE note template for new patient note (similar for return patients, with minor differences, ok to copy prior note forward and edit)
    • Please include pertinent disease history in a bullet form in HPI for both new & return visits. You may ask one of our team members for a template.
    • Please include treatment team MD names in your note. (rad onc, neurosurgery, cardiologist, primary or local onc etc)
    • This is how Dr. Junck likes to examine his patients:
      • The suggestions below apply to pt. with tumors in cerebral hemispheres.  Additional testing may be required for pts with brainstem tumors, spinal cord tumors, cancer, and those with significant systemic disease. 


         

        New patient

        Return patient

        History



        Comprehensive

        Remember bladder fn.


        Make sure you cover:

          Headaches* (cardinal sx of brain tumor)

          Sz*

          Cog sx*

          Focal sx*

          Infections if chemo pt.

          Thromboembolism sx for Gr. 3-4 or Ca

        General

        Weight

        If gr. 3-4 or Ca, calf tenderness, edema

        Other portions of gen’l exam

        Weight

        If gr. 3-4 or Ca, calf tenderness, edema

        General exam as indicated

        Cognition

        Ability to give hx, observation.

        Orientation

        Recall 3 at 5 min

        Language if L hem:

          Naming 10 objects

          Repeat phrases

          + 3-step command

        If R posterior:

          Drawing e.g. pentagons

        Ability to give hx, observ.

        Other testing where applicable

        CN II

        Fields

        Fields


        + Fundi

        Fundi if large mass effect or prev. pap.


        PERRL

        Pupils for large tumors, brainstem tumors


        EOMI

        EOMI


        V1, V2, V3 sensory



        VII motor

        VII motor


        VIII ?finger rub



        IX X palate w phonation

        Mouth if on steroids


        XI SCM or trap



        XII tongue protrusion


        Motor

        Pronator drift

        Strength UE, LE

        Finger-nose-finger FNF

        + Orbiting

        + Heel-knee-shin HKS

        Tendon reflexes

        Plantar responses

        Gait, + tandem gait

        Pronator drift

        Strength UE, LE

        FNF

        + Orbiting

        + Heel-knee-shin HKS

        + Tendon reflexes

        + Plantar responses

        Gait + tandem gait

        Sensory

        + Position

        Double simultaneous

        + Position

        Double simultaneous

    • Please include KPS (Karnofsky Performance Score) in every note
    • Please include .NCCN phase at the end of the each note (NCCN guideline attached, you can also find this online)
    • Please make sure auto-populated information are accurate, and edit if inaccurate. “Not filed” etc is inappropriate to be left alone in the note.
  2. Patient check out procedure (not revised since COVID, may need additional updates for virtual visits)
    • At the end of each visit, please complete “Follow up” and “Patient Instructions” and all orders that need to be placed to be scheduled.
    • Follow up: indicate when and for what (ie. GBM adjuvant TMZ, GBM mid-RT, Low grade oligo FU etc), complete check out note (ie CBC w diff, CMP, MRI, RV in ---weeks) so it can be scheduled at check out.

·         Orders: Please make sure all tests and referrals are ordered so they can be scheduled at check out. Also please order non-chemo medications so they are in the updated med list on AVS.


Inpatient Neuro-Oncology


Chemotherapy regimen for PCNSL

Extrapolation for methotrexate levels for discharge:

  • If less than 0.15, discharge home
  • If level is 0.2, discharge after an additional 6 hours of bicarbonate hydration
  • If level is 0.25, discharge after an additional 9 hours of bicarbonate hydration.