Challenges Facing Single-Handed Neuro-Oncologists and Smaller Centres in the UK: An Interview-Based Investigation with Proposed Solutions

Abstract

Aims

Single-handed oncology practice occurs when only one clinician covers a particular tumour site in a department. There is no quantified evidence about experiences of single-handed practice or its impact in oncology. A team supported by the Tessa Jowell Brain Cancer Mission interviewed 35 neuro-oncologists in the United Kingdom (UK) to better understand the workload, challenges and support networks of single-handed neuro-oncologists compared with those of neuro-oncologists at larger centres.

Methods and Methods

Semi-structured virtual interviews were completed: January to May 2024.

Results

Thirty-five of 58 neuro-oncologists accepted an invitation to interview. Centres were categorised as those with one neuro-oncologist (single-handed): 7 interviews; two neuro-oncologists (dual-handed): 14 interviews; three or more neuro-oncologists (multihanded): 14 interviews. At the time of the study, there were 129 neuro-oncologists working at 52 centres within 29 multidisciplinary team (MDT) networks. Most neuro-oncologists covered more than one tumour site. Single-handed neuro-oncologists described challenges including access to peer review and cover for leave. Seven of ten neuro-oncologists who had been or currently were single-handed reported a negative impact on wellbeing. Respondents described inequity of access to multidisciplinary services geographically, with neuropsychology and neurology access more difficult in smaller centres. The mean number of clinical trials open at single-handed or dual-handed centres was less than one, compared with five at multi-handed centres. However, excellent collaborative and supportive networks and initiatives at a local, regional, and national level were described.

Conclusion

Single-handed neuro-oncology practice may impact wellbeing, recruitment and retention. National research initiatives should consider ways to increase support for, and increase access to research in, single- and dual-handed centres.