Written By Neeraj Suresh on August 6, 2023

Brain tumors. Most people probably know what they are, and if you do, you most likely understand the dangers that come with them. However, you probably did not know there are so many different types of brain tumors. Brain tumors like meningiomas, which form in the meninges, the outer three layers of tissue that cover and protect the brain just under the skull, or osteomas which form in the bones of the skull and even the face. In fact, most people do not know that brain tumors are classified as either primary, meaning the tumor originates in the brain, or secondary meaning that the tumor originated elsewhere in the body and metastasized to the brain. The unfortunate truth is, if a patient has a secondary brain tumor they become extremely hard to treat due to the intricate nature of most tumors. However, for patients with primary brain tumors, getting an accurate diagnosis begins with an awareness of a primary care physician (PCP). 

Without a doubt, primary brain tumors are complex and life-threatening conditions that demand early and accurate diagnosis for effective treatment and prognosis. In primary care settings, where patients initially present their symptoms, primary care physicians (PCPs) become pivotal in recognizing and managing these tumors. While PCPs do not perform definitive brain tumor diagnoses, they can significantly impact patient outcomes by detecting warning signs early and facilitating timely referrals to specialists. A critical step in improving primary brain tumor diagnosis is raising awareness and knowledge among primary care physicians. Often, patients will present themselves within a PCP setting more frequently in the early stages of primary brain tumor development. They, however, will not report feeling ill, instead, most patients will report feeling as if they are “off.” They may even report not being able to coordinate themselves or having difficulties remembering dates and names. 

These symptoms should pose a clear warning sign to PCP that their patient could be facing some sort of neurological deficit aided by developing a brain tumor. In addition to PCPs having awareness, it is imperative that they should receive comprehensive education and training that is up to date with the latest medical literature regarding common presenting symptoms and risk factors associated with primary brain tumors. Workshops, seminars, and continuing medical education programs can help enhance their diagnostic acumen, allowing for earlier detection and intervention, and giving their patients a better chance at survival. 

One of the biggest challenges that come with primary brain tumors is their potential to mimic common ailments like Alzheimer's or dementia. Because of this, implementing routine screening protocols can aid PCPs in identifying at-risk patients promptly. Furthermore, the integration of regular neurological assessments, advanced imaging, and cognitive evaluations into routine check-ups can improve the likelihood of early detection, especially in patients with a family history of brain tumors or those with predisposing factors. Without a doubt, we must recognize the limited scope of primary care in diagnosing brain tumors definitively. Therefore it is crucial that PCPs have a clear and streamlined referral process. This can be done by establishing strong communication channels with neurologists, neurosurgeons, and neuro-oncologists allowing for swift referrals, and ensuring that patients receive specialized care without undue delays. Additionally, PCPs should remain engaged in the patient's care continuum to ensure a seamless transition and comprehensive management.

Along with in-person visits, telemedicine, and digital health technologies can also be crucial in enhancing primary brain tumor diagnosis and prognosis. These tools facilitate remote consultations with specialists, allowing PCPs to reach out to patients who may live in remote or underserved areas, improving global health. Additionally, remote monitoring of patients' symptoms and responses to treatment can aid in personalized care and timely intervention. PCPs must also collaborate effectively with other healthcare professionals to optimize the diagnosis and prognosis of primary brain tumors. A multidisciplinary approach involving radiologists, pathologists, oncologists, and supportive care teams can lead to better-informed decisions, tailored treatment plans, and improved patient outcomes.

Primary care physicians play a crucial role in the early detection, diagnosis, and prognosis of patients with primary brain tumors. By enhancing their knowledge, implementing screening protocols, improving referral systems, utilizing telemedicine, and fostering multidisciplinary collaboration, PCPs can significantly improve patient outcomes. Early recognition and timely intervention are essential in managing primary brain tumors, and empowering PCPs with the necessary tools and expertise will undoubtedly significantly impact the lives of affected individuals. Through collective effort and continuous improvement, primary care settings can become the first line of defense in the battle against primary brain tumors.

Citations

• Fine HA. The genetics of primary brain tumors: a clinical perspective. Neuroimaging Clin N Am. 2010;20(1):141-150. doi:10.1016/j.nic.2009.09.003.

• Poon MTC, Sudlow CLM, Figueroa JD, Brennan PM. Longer term survival of patients with glioblastoma in population-based studies pre and post-Temozolomide: A systematic review and meta-analysis. J Clin Neurosci. 2017;45:26-32. doi:10.1016/j.jocn.2017.07.024.

• Barton VN, Loeffler JS. Is it time to reevaluate the survival data from glioblastoma trials? Future Oncol. 2016;12(1):1-3. doi:10.2217/fon.15.314.

• Weller M, van den Bent M, Tonn JC, et al. European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol. 2017;18(6):e315-e329. doi:10.1016/S1470-2045(17)30194-8.

• Jordan JT, Gerstner ER, Batchelor TT, Cahill DP, Plotkin SR. Glioblastoma care in the elderly. Cancer. 2016;122(2):189-197. doi:10.1002/cncr.29716.

• Achey RL, Beck CA, Beran DB, et al. Anxiety and depression in Parkinson's disease: The National Parkinson Foundation Quality Initiative. Mov Disord. 2012;27(2):174-181. doi:10.1002/mds.24027.

• Subbiah IM, Thirumalasetti F, Yu RK, Wong ET. Predictors of early distant brain failure in patients with breast cancer with brain metastases. Am J Clin Oncol. 2015;38(4):381-385. doi:10.1097/COC.0000000000000101.

• Silvestri NJ, Wolfe GI. Treatment-refractory myasthenia gravis. J Clin Neuromuscul Dis. 2014;15(4):167-178. doi:10.1097/CND.0000000000000031.

• Houillier C, Wang X, Kaloshi G, et al. IDH1 or IDH2 mutations predict longer survival and response to temozolomide in low-grade gliomas. Neurology. 2010;75(17):1560-1566. doi:10.1212/WNL.0b013e3181f96282.

• Fink J, Born D, Chamberlain MC. Pseudoprogression: relevance with respect to treatment of high-grade gliomas. Curr Treat Options Oncol. 2011;12(3):240-252. doi:10.1007/s11864-011-0168-2.

• Walter FM, Penfold C, Joannides A, Saji S, Johnson M, Watts C, Brodbelt A, Jenkinson MD, Price SJ, Hamilton W, Scott SE. Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences. Br J Gen Pract. 2019 Apr;69(681):e224-e235. doi: 10.3399/bjgp19X701861. Epub 2019 Mar 11. PMID: 30858332; PMCID: PMC6428480.