Palliative Care in High-Grade Glioma: A Review

Abstract

High-grade glioma (HGG) is characterized by debilitating neurologic symptoms and poor prognosis. Some of the suffering this disease engenders may be ameliorated through palliative care, which improves quality of life for seriously ill patients by optimizing symptom management and psychosocial support, which can be delivered concurrently with cancer-directed treatments. In this article, we review palliative care needs associated with HGG and identify opportunities for primary and specialty palliative care interventions. Patients with HGG and their caregivers experience high levels of distress due to physical, emotional, and cognitive symptoms that negatively impact quality of life and functional independence, all in the context of limited life expectancy. However, patients typically have limited contact with specialty palliative care until the end of life, and there is no established model for ensuring their palliative care needs are met throughout the disease course. We identify low rates of advance care planning, misconceptions about palliative care being synonymous with end-of-life care, and the unique neurologic needs of this patient population as some of the potential barriers to increased palliative interventions. Further research is needed to define the optimal roles of neuro-oncologists and palliative care specialists in the management of this illness and to establish appropriate timing and models for palliative care delivery.

Reforming support systems of newly diagnosed brain cancer patients: a systematic review

“…Existing literature, including four previous reviews on support systems of brain tumour patients, have only focused on palliative care [26,28], interventions [45], telemedicine [46], non-medical therapies [28], and caregivers [28]. The current systematic review examined patient support services in the acute diagnostic period based on qualitative analysis of 14 studies, classified into three support domains: (1) format and level of information provided to patients [14,35,36,[39][40][41][42], (2) ongoing communication with patients [14,15,34,35,38,41,43,44,47] and (3) patient participation in treatment [5,38,[40][41][42][43][44].…”

“…Research has focused on advanced disease stages [26][27][28], caregivers [28], palliative care [26,28], and nonmedical interventions [28]. The current systematic review is unique in its focus on the psychosocial needs of brain cancer patients at the diagnostic stage, analysing strategies to improve support during this period on the macroand micro-levels.…”

Neuro-Oncological Symptoms: A Longitudinal Quantitative Study of Family Function, Perceived Support, and Caregiver Burden

“…It has been suggested that future studies within the neuro-cognitively impaired patients with dementia should assess the family dynamics and health problems of caregivers, and develop appropriate family-centered interventions that focus on strengthening interfamily support and respite services to alleviate caregiver burden (Liu & Huang, 2018). The value of incorporating a family perspective in neuro-oncological care is recommended (Crooms et al, 2020;Philip et al, 2018), with growing dyadic interventions (Milbury et al, 2019;Ownsworth et al, 2019;Xiao et al, 2018) that acknowledge the neuro-oncological caregivers' valuable support.…”

Comparison of the quality of death between primary malignant brain tumor patients and other cancer patients: results from a nationwide bereavement survey in Japan

“…Therefore, the di culty of primary malignant brain tumor patients of dying in their preferred place may be underestimated, and in other general settings, more patients might not achieve death in their preferred place. Studies have reported that EOL decision-making is often a challenge for primary malignant brain tumor patients [10,15,32]. This is due to the typical symptoms of malignant brain tumor that affect communication from an early stage of the disease.…”

“…Due to the high symptom burden and the fatal illness, the supportive care and/or end-of-life (EOL) care needs of patients with malignant brain tumors may differ from those of patients with other cancers [3][4][5][6]]. Previous studies have reported that patients with primary malignant brain tumors require more support for decisionmaking and physical symptoms than other patients with cancer during EOL care due to cognitive/functional impairment [7][8][9][10]. However, the QOL at EOL, more speci cally, the quality of dying, of patients with malignant brain tumors has not been su ciently investigated.…”