Brain tumor resections guided by magnetic resonance imaging

A major goal of surgical treatment of intracranial tumors is to achieve complete resection of the lesion while also preserving normal brain tissue and function. Conventional stereotactic systems used today to localize intracranial lesions are based on previously acquired imaging data sets. These data sets cannot provide surgeons with information about dynamic changes that occur during surgery. The recent development of intraoperative magnetic resonance imaging allows surgical resection to be performed through the eyes of the surgeon with concurrent magnetic resonance images. This advancement has revolutionized the way neurosurgical procedures are being performed.

Neuro-oncology: a clinical nurse specialist perspective

Since the introduction of corticosteroids in the 1960s little, if any, progress has been made in the prolongation of survival for patients with high grade glioma. The prognosis for this group of patients remains poor with most surviving for less than 1year. Medical treatment, aimed at controlling disease, often gives rise to major altered body image contributing to an external realization of illness. For example, patients with word-finding difficulties may now find themselves stared at because of hair loss, a consequence of radiotherapy. Those on steroids may become socially isolated as a result of cushingoid features. Partners and families do not have a ‘walk on’ part either; often patients’ physical and cognitive changes have a major impact on their lifestyle.

Photodynamic therapy: a novel treatment for primary brain malignancy

Providing therapy that conserves healthy brain tissue while effectively killing cancerous tissue remains a major challenge in the treatment of primary malignant brain tumors. The most common primary brain malignancies tend to recur despite intensive therapy, and the side effects of radiotherapy and chemotherapy can have considerable influence on health and quality of life. Photodynamic therapy (PDT) is a new technology being investigated to fulfill the need for a targeted cancer treatment that may reduce tumor recurrence and extend survival with few adverse effects. An investigational treatment, PDT employs wavelength-specific light in combination with a photosensitizing agent. The photosensitizing agent accumulates in tumor cells and is activated by nonthermal light, producing radical oxygen species that locally kill tumor cells. The selectivity of the process makes PDT appealing in the brain, where conservation of healthy tissue is vital. The most widely studied photosensitizer causes several weeks of ocular and cutaneous photosensitivity. Nursing care of the PDT patient includes intracranial pressure monitoring, neurological assessment, and intensive patient and family education. Many new photosensitizing compounds and varying methods of light delivery are being studied. This technology shows promise for the treatment of primary brain malignancies.

Support needs of brain tumour patients and their carers: the place of a telephone service

Although the survival rate for many cancers has improved over the past two decades this has not happened for most patients with a primary malignant brain tumour. Numbers of patients diagnosed with this condition each year are small, and as expertise is often very limited, information, advice, and support can be difficult for patients and carers to access. The role of the appropriately trained nurse in meeting these needs has been well researched and published literature supports the development of such roles. The use of the telephone for providing information and support has become more common in recent years. The Regional Cancer Centre in the west of Scotland covers a wide geographical area and it was considered appropriate to initiate such a service for patients and their carers in that area to provide easier access to specialist knowledge and advice and subsequently improve continuity of care. This article discusses some of the support and informational needs of patients with brain tumours and their carers, which highlight reasons for introducing the telephone service in this cancer centre. The results of a 2-year audit of the service will be also be presented.

Being a brain tumor patient: a descriptive study of patients' experiences

The purpose of this study was to describe the experience of being a patient with a brain tumor in the neurosurgery clinic of a university hospital. Eight brain tumor patients volunteered to participate. The data were collected by interviewing the participants on the day preceding brain surgery and 3-7 days postoperatively. The interviews were analyzed by inductive content analysis. Preoperatively, some patients had a fearless and calm attitude towards their illness, while others were fearful and depressed. Postoperatively, the patients' body images changed, and they were concerned about the future. They perceived their care as matter-of-fact and friendly both before and after the surgery, and they thought their basic needs were met. Some patients would have wanted more psychological support, especially after the surgery, while others found the psychological support adequate. The patients were willing to participate in decision making about their care, and they trusted the professional skill and competence of the nurses. Suggested improvements in care were to minimize the atmosphere of urgency and hurry, appoint a primary nurse for each patient, and give more attention to after-care.

The Brain Tumor Foundation of Canada: the role of facilitators for its support groups

The mission of the Brain Tumor Foundation of Canada is to fund brain tumor research, to provide patient and family support services, and to educate the public. The focus of this paper is on the role of support groups. Support groups are an important resource to support individuals with brain tumors and their families. There is an ongoing need for qualified professionals to act as facilitators for these groups. Neuroscience nurses are uniquely qualified for this role.

Impact of a family-centred approach on a couple living with a brain tumour: a case study

The diagnosis of a malignant brain tumour can be devastating for both patients and their families. Despite neurological and cancer treatment advances, there has been little progress in extending life expectancy for these patients. Cassileth et al. (1985) suggest that of all types of cancer, brain tumours cause the most psychosocial repercussions for the family. The brain tumour clinical nurse specialist (CNS) is in a strategic position to intervene with families along the continuum of care by using a family-oriented approach which can facilitate their adaptation to this health problem. The present case study will describe the illness experience of one couple where a member had a brain tumour. The process of assessment, interventions and outcomes will be highlighted. The CNS utilized the Calgary Family Assessment Model (CFAM) (Wright & Leahey, 1984) and Calgary Family Intervention Model (CFIM) (Wright & Leahey, 1994) to guide her work with this family. An example of an intervention was the illness narrative approach. In this approach the concepts of illness experience, perceptions, beliefs and support were used as part of the therapeutic modality which served to enhance the coping strategies of the couple and decreased their crisis situation. This collaborative style of nursing promoted the well-being throughout the illness trajectory of both the family and the CNS.

Issues in families of children with brain tumors

PURPOSE/OBJECTIVES

To determine the needs of children with brain tumors and their parents/guardians and siblings during the six stages of illness: diagnosis, hospitalization, posthospitalization, adjuvant treatment, recurrence, and terminal or reported cured.

DESIGN

A cross-sectional, qualitative study of families using focus group methodology.

SETTING/SAMPLE

Families with a child diagnosed with a brain tumor recruited from the practices and clinics of several major teaching hospitals in the New York metropolitan area. Families traveled as far as 70 miles for the group meeting. Varying ethnic groups and family structures were represented.

METHODS

Groups were separated into parents/guardians, siblings, and affected children. The children's groups were divided further into age 10 and older and younger than age 10. During the focus group, moderators followed an outline of topics identified from family interviews, the literature, and content experts that were important to families in similar situations. An assistant moderator took detailed notes, and the entire group meeting was audiotaped. Information was transcribed and analyzed using qualitative analysis techniques.

FINDINGS

11 focus groups met involving 7 affected children, 24 adults, and 19 siblings. Issues identified as important by the group members fell into four categories: Interaction With Healthcare Providers, Medical Information/Education, Healthcare Utilization and Treatment, and Psychosocial Issues. The needs of family members differed at various stages of the illness.

CONCLUSIONS

The particular impact of the four major areas of concern differed by family role and stage of illness.

IMPLICATIONS FOR NURSING PRACTICE

To provide optimal care, healthcare professionals must be aware of the family's composition and support systems and the impact that the illness has on individual family members at each stage of illness.

Evaluation of a nurse-led telephone clinic in the follow-up of patients with malignant glioma

The aim of this study was to evaluate nurse-led telephone follow-up (NTF) for patients with high-grade glioma as an alternative to conventional clinic follow-up (CCF) and to assess patient satisfaction with this approach. Patients who were completing primary therapy for high-grade glioma and were suitable for CCF were offered the alternative of nurse-led telephone follow-up. NTF was arranged by the nurse at mutually agreed times. Assessment was by open discussion and a semistructured questionnaire, together with the Barthel Activities of Daily Living Index. Formal medical assessment in the clinic was arranged at 4-month intervals or earlier if indicated. Twenty-two patients were asked to complete a satisfaction questionnaire. Between February 1996 and October 1997, 43 patients with high-grade glioma, one with primitive neuroectodermal tumour and one with oligoastrocytoma agreed to be monitored by NTF. Their median survival from diagnosis was 16 months (95% confidence interval 13-23 months). At the time of analysis, the median time of follow-up by the telephone clinic was 6 months (range 2-21), with symptomatic progressive disease the reason for discontinuation of NTF in all patients. Two-hundred and fifty-four telephone calls were made, of which 234 were routine and 20 non-routine, being initiated by the patients or their carers. NTF was considered as a sufficient replacement for CCF during the stable phase of the disease. There were 41 unscheduled clinic visits, of which 31 were at the time of progression and usually initiated at NTF. The majority of unplanned visits were due to a change in symptoms and would not have been avoided with CCF carried out at the same time intervals. Patient satisfaction was high, with a median satisfaction score of 9, (range 3.6-10 ) on a scale of 0-10. NTF provides an alternative approach to conventional hospital attendance and moves the emphasis away from cancer surveillance to a more patient centred supportive model. It can be carried out without apparent detriment to the patient and is associated with high satisfaction rating.

Temozolomide (Temodal) for treatment of primary brain tumours

Although the outlook for patients with malignant gliomas continues to be very poor, progress in neurosurgery and radiotherapy, supported by new development in chemotherapy, offer some hope for the future. Temozolomide has recently been introduced by Schering-Plough Ltd (Welwyn Garden City, UK) as a new treatment which merits further investigation in this situation.

[Home palliative care of brain tumor patients from our clinic]

This study investigated whether or not home palliative care of brain tumor patients was possible and various ideas for accomplishing this, over the 2 1/2 years since our clinic was opened. There were 22 patients, aged 42-72 years, comprising 7 cases of glioblastoma, 14 cases of metastatic brain tumor, and 1 case of unknown origin. The control of intracranial hypertension and attacks of convulsion was possible with oral medication or suppositories, but not injection. The prognosis of cancer patients which changed home care showed no remarkable changes, and the home care rate was 53%. Malignant brain tumor patients were able to enjoy time with their families at home during the terminal stage, and die with dignity.

Moveable intraoperative magnetic resonance imaging systems in the OR

Recently, the Seaman Family Magnetic Resonance Research Center, Calgary, Alberta, Canada, unveiled leading technology with its moveable intraoperative magnetic resonance imaging (MRI) system. The new system, which is housed in the OR, allows surgeons to use well-established neurosurgical techniques and instrumentation with the convenience of moving the high-resolution magnet in and out of the surgical field at any time. This mobility provides surgical team members with updated images that are vital to ensuring quality and determining the effect of surgery on brain structure and function. Based on experiences with the first 48 patients, this article describes the intraoperative MRI method and provides pertinent guidelines for safe perioperative care using this innovative MRI system.

Relationship between fatigue and quality of life in patients with glioblastoma multiformae

PURPOSE/OBJECTIVES

To evaluate changes in fatigue at the time of diagnosis (Time 1) and two weeks after the completion of radiation therapy (Time 2) and to determine the relationship between fatigue and quality of life (QOL) at each time interval in patients with glioblastoma multiformae (GBM).

DESIGN

Descriptive study to evaluate fatigue and QOL.

SETTING

Neuro-oncology clinic for accrual. Clinic, home, or office for patients interviews.

SAMPLE

60 adult patients diagnosed with GBM who received radiation therapy.

METHODS

Participants completed a demographic data sheet, the Profile of Mood States, and the Multidimensional Quality of Life Scale-Cancer Version 2 at both time points.

MAIN RESEARCH VARIABLES

Fatigue and QOL.

FINDINGS

Fatigue significantly increased from Time 1 to Time 2 (t = -2.69, p = 0.009). Increases in fatigue were associated with significant decreases in QOL at Time 1 (r = -0.57) and Time 2 (r = -0.60).

CONCLUSIONS

Patients with GBM experience increases in fatigue after radiation therapy. Increases in fatigue are associated with decreases in almost all aspects of patients' QOL.

IMPLICATIONS FOR NURSING PRACTICE

Nurses must provide patients with information about the occurrence of fatigue during radiation therapy and recommend interventions to deal with this devastating symptom.

The distress associated with cranial irradiation: a comparison of patient and nurse perceptions

Distress associated with attendance at a radiotherapy treatment center for cranial radiotherapy was assessed in 10 consecutive patients using a method first employed by Munro et al. (1). This involved using a series of cards, each with a potential side effect of radiotherapy printed on it. The subjects were asked to highlight which side effects were a problem to them. The same method was used to determine the perceptions of nurses caring for patients receiving cranial radiotherapy, and the results were compared. This preliminary study suggests that the patient group found the physical side effects of their treatment most distressing, with "tiredness" and "hair loss" predominating. The nurse group had a tendency to overestimate the amount of side effects experienced by patients. They were able to choose quite successfully many of the more distressing side effects mentioned by the patient group. The study indicates the need for further research into the specific problems of patients undergoing cranial radiotherapy.