Intended for healthcare professionals

Practice Guidelines

Primary and metastatic brain tumours in adults: summary of NICE guidance

BMJ 2018; 362 doi: (Published 17 July 2018) Cite this as: BMJ 2018;362:k2924
  1. Alex Bates, guideline lead1,
  2. Eva Gonzalez-Viana, systematic reviewer1,
  3. Garth Cruickshank, clinical advisor, professor of neurosurgery, consultant neurosurgeon2,
  4. Tom Roques, chair of Guideline Committee, consultant clinical oncologist3
  5. on behalf of the Guideline Committee
  1. 1National Guideline Alliance, Royal College of Gynaecologists and Obstetricians, London NW1 4RG, UK
  2. 2University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
  3. 3Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
  1. Correspondence to: G Cruickshank garth.cruickshank{at}

What you need to know

  • Outcomes of a brain tumour vary substantially depending on its grade, location, and other factors, with life expectancy after treatment ranging from weeks (recurrent glioblastoma) to decades (completely excised, low grade glioma)

  • Effects of the tumour and side effects of treatment can manifest months or years after treatment and can affect behaviour, cognition, and personality

  • Treat any change in neurocognitive signs and symptoms as a potential tumour recurrence requiring prompt referral for investigation

  • Ensure people with brain tumours have a named healthcare professional documented in their medical records who has responsibility for coordinating health and social care support

  • Consider whether a neurological rehabilitation assessment of physical, cognitive, and emotional function might be required for a person with a brain tumour at any time in the course of their disease

Although primary malignant brain tumours represent only 3% of all cancers, they result in the most life-years lost of any cancer.1 Survival with malignant brain tumours has remained poor despite improvements in diagnosis and management (table 1), and it was believed that survival and quality of life could be improved by standardising care across the country with a guideline. Over 60% of people with primary brain tumours present at and are diagnosed by accident and emergency services rather than by general practitioners or in specialist settings.2 Brain metastases are the most common brain tumour to present in primary care, but other forms of brain cancer are seen.

View this table:
Table 1

Care requirements for brain tumours by approximate median survival

Although brain tumours are usually managed by specialist teams, primary care and non-specialist teams have an important role in patients’ long term care, particularly when it comes to considering the longer term cognitive, physical, and mental health effects of the tumour and its treatment (table 1).

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