Skip to main content

Neurosurgical Oncologists: Pushing the Field Forward

By Neuro-oncology, Tumor, Tumor SeriesNo Comments

The role of neurosurgical oncologists in the laboratory is more important than ever. The emergence of targeted therapies and immunotherapies has shown us that we are at an inflection point for cancer care. We are on the verge of gaining new insights into the causes of cancer and identifying novel pathways and potential new targets. The next-generation research tools available to us now yield unprecedented amounts of data and afford a granularity far beyond what our predecessors could have imagined. While we have historically made substantial contributions to neuro-oncology, our continued participation in the laboratory at this pivotal moment remains crucial.

Today we have access to tissue and can provide unique clinical insights to focus research efforts on the most critical aspects of cancer biology. Furthermore, we can translate our findings from the laboratory to the clinics. In addition to running traditional Phase I, II or III clinical trials with companion correlative studies, concepts like Phase 0 studies are now allowing us to forego mouse and animal studies to explore the mechanism of action of our therapies directly in patients. Phase 0 studies use only a few doses of a new drug in a very small number of people. By design, these studies allow us to examine tissue procured from the operating room and directly study the effects of the drug of interest. Neurosurgical oncologists’ role is central to this process.

Given these basic and translational studies, a team approach is required. While we celebrate being a “triple threat,” neurosurgeons must be careful to avoid practicing and researching in a vacuum — running experiments in isolation risks generating insular findings. The most important questions in oncology require the input of an array of talented individuals with diverse expertise. In addition to working with our colleagues in neuro-oncology, radiation oncology, neuroradiology, neuropathology and biostatistics, among others, we must adopt a culture of diversity, equity and inclusion. Diversity will ensure success. Leadership and learning to work in teams is also a core skill set that needs to be valued and taught to make progress. Our path forward, growth and success depend on this.

It is essential to acknowledge the circumstances that threaten the future of a neurosurgical oncologist. As medicine changes, protected research time is considered more of a luxury as institutions face pressure to consolidate and cut costs. As most compensation models are based on productivity, there is a subsequent bias towards valuing clinical productivity over research accomplishments. In addition, with reduced resident work hours, residents are seeking to augment their clinical experience by doing fellowships during their research years. To ensure that we continue to train neurosurgical oncologists, we must actively promote and value research with a concerted effort to foster the next generation of surgeon-scientists. Research is what will drive the field forward, and we risk sacrificing innovation and progress if we forego this.

National Institutes of Health (NIH) funding has become increasingly challenging to obtain. While neuro-oncologists have successfully received funding, 26% of all R01s awarded to neurosurgeons are in neuro-oncology — the paylines remain in the single digits. As mentioned above, to do more, we need to increase our impact by applying for grants as a multidisciplinary team. As an objective indicator of the magnitude of team science, the highest funded neurosurgery department in 2019 received about $18 million in NIH funding, while the highest funded neurosciences program received about $49 million and the highest internal medicine program received about $216 million in NIH funding.

The awards’ size has not grown even if one successfully obtains funding. We are experiencing the stark reality of dramatically rising research costs in setting fixed grant awards. At a departmental level, with decreasing reimbursements for clinical work, departments have less and less funding to carry over to fund academic efforts. As a result, we need to work creatively with industry and philanthropy to ensure that research output keeps pace with the available technologies.

We live in exciting times — we can gain greater insights into tumors than ever before. Not only are we learning more about tumors, but we are also seeing therapies affecting the natural course of advanced diseases that would, in some cases, have been deemed untreatable only a decade ago. We are now moving towards team science, but in parallel, we are also facing threats, and the classic physician-scientists are becoming endangered. We must continue to protect, value, and participate in research. The lives of our future patients depend on it.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NSTumorSection and using the hashtag #TumorSeries.

 

Michael K. Lim, MD
Department of Neurosurgery, Stanford University
Stanford, Calif

Cross-Post: Prior Authorization Is Hurting Our Patients

By Cross Post, Prior AuthorizationNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will be of interest to our readers. Today’s post originally appeared in MedPage Today on June 25. In the op-ed, neurosurgeon and chair of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Washington Committee John K. Ratliff, MD, FAANS, discusses how prior authorization is hurting patients and how bipartisan legislation in Congress can help address these problems in Medicare Advantage.

Dr. Ratliff points out that prior authorization, an administrative process requiring physicians to obtain pre-approval for medical treatments or tests before rendering this care to their patients, is becoming more common. Obtaining approval from insurers is burdensome and costly to physician practices. Without timely care, his patients often face permanent neurologic damage and sometimes death.

The Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018) would create an electronic prior authorization process and pave the way for immediate approvals for medical services that are routinely approved. This legislation would also improve transparency on the use of prior authorization, ensure that qualified medical personnel review prior authorization requests and protect beneficiaries from disruptions in care.

Click here to read the full article.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by using the hashtag #FixPriorAuth and following @Neurosurgery.

Our 500th Blog Post: Amplifying Neurosurgery’s Voice

By HealthNo Comments

For the past decade, Neurosurgery Blog: More Than Brain Surgery has investigated and reported on how health care policy affects patients, physicians and medical practices. Posts have discussed the state of neurosurgical sub-specialties and promoted key health care policy and advocacy initiatives to ensure patients’ timely access to care, improve neurosurgical practice and foster continued advancement of neurological surgery.

Its health policy reporting efforts include multiple topic months and guest blog posts from key thought leaders and members of the neurosurgical community. To mark the 500th post, we combed through the Neurosurgery Blog archives to highlight our most popular blog posts and focus series that showcase the current state of neurological surgery.

The Neurosurgery Blog’s 10 top posts:

The Neurosurgery Blog’s top focus series:

  • WINS Series. The year 2020 marked the historic 30th anniversary of the founding of Women in Neurosurgery (WINS), bringing with it an exciting time for the WINS community and neurosurgery. To celebrate the 30th anniversary of WINS, Neurosurgery Blog published a series of articles highlighting the section’s goals — to educate, inspire and encourage women neurosurgeons to realize their professional and personal goals.
  • COVID-19 Series. The COVID-19 pandemic has significantly impacted neurosurgical practices across the country. To highlight the effects of the pandemic on neurosurgery, Neurosurgery Blog published a series of articles on the impact of COVID-19.
  • Spine Care Series. The Neurosurgery Blog published a series of articles on the spine to shed light on spine facts, innovation and the role of spine interventions. Today, spine-related disability has been called an epidemic. Misinformation regarding spine care in the U.S. is a significant hindrance to understanding the critical issues surrounding the care of patients with spinal conditions.
  • Military Faces of Neurosurgery Series. To pay tribute to the contributions of the many military neurosurgeons who have made significant contributions and sacrifices — whether on the battlefield, in the operating room or research lab — the Neurosurgery Blog published a series on Military Faces of Neurosurgery. Throughout history, neurosurgeons have served our country with distinction and grace. Read how former AANS president Roberto C. Heros, MD, FAANS(L), volunteered for the ill-fated Bay of Pigs invasion. Remember the horrors of the Vietnam War, as seen through the eyes of Patrick J. Kelly, MD, FAANS(L), while he was stationed in Da Nang during the bloodiest year of that conflict.
  • Physician Burnout Series. To explore and highlight the rising prevalence of burnout among clinicians in recent years, the Neurosurgery Blog published articles bringing physician wellness to the forefront of the profession and offering strategies to reduce physician burnout.
  • Faces of Neurosurgery Series. The Neurosurgery Blog published a Faces of Neurosurgery interview video series. Conducted by Kurt A. Yaeger, MD, a member of the AANS/CNS Communications and Public Relations Committee, these neurosurgery luminaries are asked about their early mentors, proudest achievements and advice for neurosurgical residents. Click here to watch the series.

Thanks for following Neurosurgery Blog, and stay tuned for great content in the coming decade!

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by using the hashtag #Neurosurgery and following @Neurosurgery.

Cross-Post: ‘I’m a Neurosurgeon Who Can’t Move. Now What?’

By Cross Post, Spine CareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will be of interest to our readers. Today’s post originally appeared in MedPage Today on June 15. In the op-ed, David J. Langer, MD, FAANS, recounts a life-changing accident during a ski trip that resulted in a spinal cord injury and a feeling of powerlessness for the practicing neurosurgeon and star on the Netflix series Lenox Hill.

Moments after Dr. Langer fell while skiing in Colorado, he realized he couldn’t move his legs, “I’m a neurosurgeon who can’t move, I thought. Now what?” After being airlifted to a Denver hospital, he was diagnosed with central cord syndrome ⁠— his spinal cord was injured, but only temporarily. “Feeling valued and humbled, I returned home to my own team to repair my spine,” according to Dr. Langer. The excellent care he received in Colorado and at home in New York now reminds him to keep patients’ humanity front and center.

Click here to read the full article.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by using the hashtag #Neurosurgery and following @Neurosurgery and @DrDavidLanger.

Cross-Post: Perverse Health-Care Incentives Endanger Spine Patients

By Access to Care, Cross Post, Spine CareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will be of interest to our readers. Today’s post originally appeared in The American Spectator on May 21. In the op-ed, neurosurgeons Richard Menger, MD, MPA and Anthony M. DiGiorgio, DO, MHA voice their support of Louisiana HB 941, a bill in the Louisiana State Legislature that would allow only spine surgeons to perform spine surgery.

Non-surgeons have begun performing spine surgery at such a rate that it became necessary for the leading spine organizations — including the American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS) and AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves — to adopt a position statement on the issue. As pointed out by Drs. Menger and DiGiorgio, it is a fairly straightforward premise that a physician should be a spine surgeon to perform and bill for spine surgery.

Click here to read the full article.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by using the hashtag #SpineSurgery and following @Neurosurgery and @SpineSection.

Improving the Field of Neurosurgery through Brain Tumor Advocacy

By Brain Tumor, Tumor, Tumor Series, White HouseNo Comments

Working with patient advocates is important for neurosurgeons and neurosurgeons in training. While neurosurgeons help patients through clinical work and conduct innovative research to advance treatment options, advocacy can have an outsized impact on patients across the U.S. Neurosurgeons who participate in patient advocacy gain a better understanding of the priorities of patients, their families and those who care about them.

As a member of the National Brain Tumor Society (NBTS) board of directors, I have had the opportunity to better understand the concerns and priorities of patients dealing with brain tumors and their caregivers. This helps me educate the broader patient population about brain tumor neurosurgery, clinical trials and what my institution offers. NBTS, its Informed in 30 educational program and virtual meetings with brain tumor community members have changed how I communicate with patients, including discussing treatment options and clinical trials. I have learned a great deal about how I can become a better neurosurgeon and think we would all benefit from such education, thus improving our delivery of patient care.

Patient advocacy can do much more than an individual neurosurgeon scientist can to attract research funds to the field. As an individual, I can only apply for so many grants. Patient advocates, tapping into the power of patient stories, can influence lawmakers, friends and families to provide funding for research to benefit the field of neurosurgery and neuro-oncology. NBTS annually disburses approximately $2 million to researchers from across the country. By participating in this process, I can have a hand in steering the direction of not just my lab but that of researchers across the country. In this way, I can encourage rigorous and innovative research that acknowledges the reality of this challenging disease and promote the critical need for neurosurgeons to be involved in clinical trials.

Patient advocate groups like NBTS can have an outsized impact on public policy and, importantly, serve as a platform for patients, caregivers and brain cancer medical providers to have a voice on critical issues facing our cause to ultimately eliminate these diseases and reduce disease burden. While I can call my senator as an individual to advocate for policy changes needed for our field, a group like NBTS has the resources necessary to make long-term relationships with lawmakers across the country, raising the critical needs of their constituents. Like the AANS/CNS Washington Committee, NBTS understands the needs of its volunteers and advocates. They combine the power of all of these individuals to encourage our representatives in Washington to address our concerns.

Every year, NBTS holds the Head To The Hill event (#Head2Hill), where brain tumor patient advocates descend upon Washington, DC, in person or virtually, to present a united front on key issues for the community. While increased federal research funding is a priority every year, directly impacting neurosurgeon-scientists, this year, NBTS also focused on extending telemedicine rules created during the COVID-19 pandemic. I participated in Head to the Hill in May. It was a wonderful experience working side by side with other brain tumor advocates from Georgia on these critical issues. Additionally, through NBTS’s Research Roundtable Program, I have been able to bring expertise to regulatory policy with the Food and Drug Administration in workshops and meetings on clinical trial design and endpoints.

Patient advocacy can also lead to rewarding and one-of-a-kind opportunities in one’s career. An exciting example is my recent opportunity to introduce President Joseph R. Biden, Jr. to unveil the extension of the Cancer Moonshot initiative. This initiative was established in 2016 by then-President Barack Obama to support cancer research and progress in treatment and care.

At its launch, the Cancer Moonshot set forth three ambitious goals: accelerate scientific discovery in cancer, foster greater collaboration, and improve data sharing. On Feb. 2, President Biden announced additional steps to “reignite” the Cancer Moonshot initiative to “ending cancer as we know it” by halving the number of cancer deaths in the U.S. in the next 25 years. Leaders from NBTS had a hand in crafting the initial Cancer Moonshot and sat with me at this prestigious event. Together, I am confident we will make real change for the brain tumor community and someday find a cure and better quality of life for our patients.

I would strongly encourage other neurosurgeons to establish relationships with patient advocates in their fields. My time working with NBTS has been an invaluable tool to improve the patient care that I deliver, improve research in the area of brain tumors and have a direct impact on public policy.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NSTumorSection and using the hashtag #TumorSeries.

Edjah K. E. Nduom, MD, FAANS
Emory University School of Medicine, Department of Neurosurgery
Atlanta, Ga.

Cross-Post: Brain Tumors in Children

By Brain Tumor, Pediatrics, Tumor, Tumor SeriesNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting pieces from other publications that are worthy of sharing with our readers. Since we are in the middle of our focus series on tumors, we wanted to bring attention to an article published in The New England Journal of Medicine (NEJM) on May 19. Alan R. Cohen, MD, FACS, FAAP, FAANS, discusses recent changes to the classification and management of brain tumors in children. In 2021, the World Health Organization introduced changes in brain tumor taxonomy, emphasizing molecular diagnostic features. These changes reflect the trend of assigning diagnostic categories based on genetic features that, in many cases, drive prognosis and offer potential targets for treatment.

Brain tumors are the leading cause of death from cancer in children. Tumors of the central nervous system (CNS) account for 20% of childhood cancers and are second only to leukemia in frequency. Recent diagnostic and therapeutic advances have improved survival and quality of life for many children with CNS cancers. Sadly, however, the prognosis for many children with brain tumors remains poor.

Click here to read the full NEJM article.

To learn more about Dr. Cohen’s work as a pediatric neurosurgeon and how he uses humor (and Elvis) to bring joy to his patients and their families, check out this oldie but goodie from Good Morning America.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NSTumorSection and using the hashtag #TumorSeries.

Alan R. Cohen, MD, FACS, FAAP, FAANS
Department of Neurosurgery, Johns Hopkins University School of Medicine
Baltimore, Md.