Complexity of neuro-oncological in-hospital consultations: a multicentre study

Oncological patients may require evaluation by a neurologist when they are admitted to hospital. The aim of our study was to determine the frequency and characteristics of hospital interconsultations (IC) received by the neurology department concerning oncology patients admitted to the hospital.

A retrospective multicentre study analysing IC with neurology concerning onco-haematological patients admitted over 5 consecutive years (2016-2020) in 4 tertiary hospitals in Spain was carried out.

A total of 2091 IC from 1710 patients were analysed, most of them male (55.5%; 969/2091) with a median age of 60.5 years (range 15-92). Most of the ICs came from the medical oncology (43.2%; 904/2091) and hematology (42.2%; 882/2091) departments. Neuro-oncological ICs accounted for approximately 17% (2091/12 242) of the total number of ICs performed in the neurology department during the 5 years included in this study. The most frequent reasons for consultation were limb motor deficit (18.3%; 381/2077), confusional syndrome (14.1%; 292/2077), epileptic seizures (12.2%; 254/2077), and headache (8.1%; 169/2077). The most frequent associated tumours were lung cancer (18.3%; 383/2089), leukaemia (19%; 396/2089), lymphoma (17.1%; 357/2089), and primary brain tumor (12.1%; 353/2089). The majority (69.9%; 1460/2089) of patients were undergoing active or recent cancer treatment. Final neurological diagnoses included metabolic encephalopathy (11.2%; 234/2091), tumor progression (11%; 231/2091), cerebral vascular complications (10.1%%; 212/2091), metastases (9.1%%; 191/2091), and leptomeningeal dissemination (8.9%%; 186/2091). A total of 15.4% (323/2091) of the ICs were closed with an undetermined diagnosis. The median time that the ICs were open was 3 days (range, 1-152).

ICs concerning onco-haematological patients are heterogeneous, with an increasing incidence and complexity, requiring management by neurologists with experience in neuro-oncological patients.