Tobias Steigleder1, Stephanie Stiel, Christoph Ostgathe. 1. aDepartment of Palliative Medicine, Comprehensive Cancer Centre CCC EMN bDepartment of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Abstract
PURPOSE OF REVIEW: Patients with brain tumours show a high symptom burden, and symptoms are difficult to treat and prone to be overlooked. This review of publications dealing with advanced stages of brain tumours tries to assess the knowledge gained in the past 2 years and to develop an outlook for further investigations. RECENT FINDINGS: We searched for publications on advanced brain tumours in a palliative medicine setting. Of 138 publications retrieved by search in PubMed, 22 publications met our criteria for inclusion. We predefined categories of interest: epidemiology and treatment of symptoms; quality of life; and impact on next of kin, caregivers, medico-social system and decision-making. SUMMARY: Data suggest that patients with primary or metastatic brain tumours often have a high symptom burden and unmet needs for palliative care, and symptoms are hard to diagnose; patients suffer often and early from cognitive impairment but are rarely appropriately prepared concerning end-of-life wishes. This reflects on their caregivers' burden as well. For symptomatic treatment of common symptoms such as fatigue, depression and cognitive impairment, methylphenidate has established an important role. For assessment of these symptoms, a shortened questionnaire Quality of Life Questionnaire-15-Palliative shows potential. Cancer-directed therapy in advanced stages of brain tumours has to be weighed critically. To assess adequate strategies to help patients and caregivers with the challenges of brain tumour-specific symptoms, randomized intervention studies are necessary. The same accounts for cancer-directed treatment in relation to quality of life in advanced stages of brain tumours.
PURPOSE OF REVIEW: Patients with brain tumours show a high symptom burden, and symptoms are difficult to treat and prone to be overlooked. This review of publications dealing with advanced stages of brain tumours tries to assess the knowledge gained in the past 2 years and to develop an outlook for further investigations. RECENT FINDINGS: We searched for publications on advanced brain tumours in a palliative medicine setting. Of 138 publications retrieved by search in PubMed, 22 publications met our criteria for inclusion. We predefined categories of interest: epidemiology and treatment of symptoms; quality of life; and impact on next of kin, caregivers, medico-social system and decision-making. SUMMARY: Data suggest that patients with primary or metastatic brain tumours often have a high symptom burden and unmet needs for palliative care, and symptoms are hard to diagnose; patients suffer often and early from cognitive impairment but are rarely appropriately prepared concerning end-of-life wishes. This reflects on their caregivers' burden as well. For symptomatic treatment of common symptoms such as fatigue, depression and cognitive impairment, methylphenidate has established an important role. For assessment of these symptoms, a shortened questionnaire Quality of Life Questionnaire-15-Palliative shows potential. Cancer-directed therapy in advanced stages of brain tumours has to be weighed critically. To assess adequate strategies to help patients and caregivers with the challenges of brain tumour-specific symptoms, randomized intervention studies are necessary. The same accounts for cancer-directed treatment in relation to quality of life in advanced stages of brain tumours.
Authors: J A F Koekkoek; L Dirven; E M Sizoo; H R W Pasman; J J Heimans; T J Postma; L Deliens; R Grant; S McNamara; G Stockhammer; E Medicus; M J B Taphoorn; J C Reijneveld Journal: J Neurooncol Date: 2014-08-24 Impact factor: 4.130