Palliative and Supportive Care in Neuro-oncology

Deborah A. Forst, MD Neuro-oncology p. 1673-1685 December 2020, Vol.26, No.6 doi: 10.1212/CON.0000000000000940
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PURPOSE OF REVIEW This article reviews the supportive care needs of patients with primary brain tumors and their caregivers, outlines the management of selected common symptoms of patients with brain tumors, and describes challenges and opportunities in providing palliative care for this population.

RECENT FINDINGS Patients with primary malignant brain tumors generally have a poor prognosis and experience progressive neurologic decline and significant physical and psychological symptoms. Management of these symptoms, including fatigue, mood disorders, and the manifestations of cerebral edema, can be challenging. Caregivers for these patients have high rates of psychological distress and report significant caregiving burden. Although the benefit of early palliative care for patients with other advanced solid tumors is well established, our understanding of the role of palliative care in neuro-oncology is incomplete, and thus palliative care and hospice services remain underutilized.

SUMMARY Patients with brain tumors and their caregivers have significant supportive care needs, which often differ from the needs of patients with cancers outside of the nervous system. Clinicians face challenges associated with managing patients’ symptoms and adequately facilitating prognostic understanding and decision making. Palliative care and hospice services may offer important benefits for this population.

Address correspondence to Dr Deborah A. Forst, Massachusetts General Hospital, 55 Fruit St, Yawkey 9E, Boston, MA 02114, [email protected].

RELATIONSHIP DISCLOSURE: Dr Forst has received personal compensation for speaking engagements from the American Academy of Neurology and NYU Langone Medical Center and for travel from INOVIO Pharmaceuticals and has received research/grant support from the American Cancer Society, Conquer Cancer/The American Society of Clinical Oncology (ASCO) Foundation, and the Palliative Care Research Cooperative Group.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Forst reports no disclosure.

© 2020 American Academy of Neurology.