The Palliative Care of Patients with Brain Metastases

Harrison, Rebecca; Bruera, Éduardo

doi:10.1007/978-3-030-42958-4_54

Cited by 1 publication

(1 citation statement)

References 119 publications

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“…69 Generally, clinicians should express respect for patients' right to decline interventions 70 but should recognize that such interventions can have palliative roles by preventing debilitating neurological impairment and concomitant end-of-life suffering. 71,72 Palliative radiotherapy, including stereotactic radiosurgery for patients with advanced cancer with brain metastases, has been pursued, 73,74,75,76 as have deep brain stimulation for Parkinson disease management near the end of life 77 and palliative decompressive spinal surgery for patients with metastatic spinal cord compression. 78,79,80,81 Care Planning Unlike decisions about specific palliative interventions, decisions about stroke care are typically made quickly, given the urgency of acute stroke, its impact on patients' capacity to participate in decision making, and the exquisite time sensitivity of implementing acute stroke interventions.…”

Section: Equity and Evolving Therapiesmentioning

confidence: 99%

When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

Young

Regenhardt

Sokol

et al. 2021

AMA Journal of Ethics

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Noncurative surgeries intended to relieve suffering during serious illness or near end of life have been analyzed across palliative settings. Yet sparse guidance is available to inform clinical management decisions about whether, when, and which interventions should be offered when ischemic stroke and other neurological complications occur in patients whose survival is extended by other novel disease-modifying interventions. This case commentary examines key ethical and clinical considerations in palliative neuroendovascular care of patients with acute stroke.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CaseMr J is a 64-year-old man with metastatic non-small cell lung cancer (NSCLC), who, while eating, abruptly developed right hemiplegia and aphasia. He had been diagnosed 10 months earlier with NSCLC; his estimated life expectancy was approximately 1 year. After a course of chemotherapy with pemetrexed and carboplatin, Mr J started pembrolizumab, an antiprogrammed death-1 immune checkpoint inhibitor offered possibly to extend his life but not as a cure for his cancer. 1,2 Since diagnosis, Mr J has suffered multiple hematologic complications, including thrombosis and hemorrhage. When brought to an emergency department, he was confirmed as full code and intubated on arrival due to poor mental status and aspiration risk. Computed tomography (CT) imaging of his head and neck revealed normal brain parenchyma and occlusion of the proximal left middle cerebral artery (MCA), which supplies blood to most of the brain's left hemisphere, including areas critical for language and right-side sensorimotor function. 3 The mechanism of Mr J's left MCA occlusion was presumed to be thromboembolism, to which he was predisposed by hypercoagulability of malignancy, pembrolizumab, 4,5,6 and intracardiac hemostasis, given his known low left ventricular ejection fraction.

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