Palliative Care, End-of-Life Care, and Advance Care Planning in Neuro-oncology

Tobias Walbert, MD, PhD Neuro-oncology p. 1709-1726 December 2017, Vol.23, No.6 doi: 10.1212/CON.0000000000000538
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ABSTRACT: Purpose of Review: Despite new therapeutic approaches, most patients with high-grade glioma face limited overall survival and have a high symptom burden throughout their disease trajectory, especially in the end-of-life phase. This article provides an overview of the role of palliative care in neuro-oncology. Management recommendations are made for neurologic symptoms in patients with advanced brain tumors, including headaches, nausea, and fatigue. Special attention is given to how and when to involve subspecialty palliative care and hospice services to improve symptom management during active tumor treatment and in the end-of-life phase of patients with brain tumors. Advance care planning and end-of-life goals should be addressed early in the disease trajectory; this article provides a road map for these discussions.

Recent Findings: The high symptom burden of patients with brain tumors affects their quality of life as well as their ability to make treatment decisions. It is therefore warranted to involve patients with high-grade glioma in treatment decision making early in the disease course, with a focus on end-of-life care and advance care planning. Research in other World Health Organization grade IV cancers has shown that the early involvement of specialty palliative care improves quality of life and caregiver satisfaction. Patients with brain tumors should be actively screened for fatigue, and underlying factors such as hormone deficiencies, low blood counts, and sleep issues should be addressed before focusing interventions for tumor- and treatment-related fatigue.

Summary: Palliative care can address typical symptoms, such as fatigue, nausea, and headaches that have the potential to severely disable patients with brain tumors. Advance care planning should be introduced proactively and early in the disease trajectory to ensure a dignified death and improved caregiver bereavement.

Address correspondence to Dr Tobias Walbert, Departments of Neurosurgery and Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202,

Relationship Disclosure: Dr Walbert serves on the editorial board of Neuro-Oncology Practice and on the advisory boards of AbbVie Inc and Novocure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Walbert reports no disclosure.

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© 2017 American Academy of Neurology