1
|
Chen JW, Chanbour H, Bendfeldt GA, Gangavarapu LS, Karlekar MB, Abtahi AM, Stephens BF, Zuckerman SL, Chotai S. Palliative Care Consultation Utilization Among Patient Undergoing Surgery for Metastatic Spinal Tumors. World Neurosurg 2023; 178:e549-e558. [PMID: 37532016 DOI: 10.1016/j.wneu.2023.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE In patients undergoing surgery for spinal metastasis, we sought to: (1) describe patterns of palliative care consultation, (2) evaluate the factors that trigger palliative care consultation, and (3) determine the association of palliative care consultation on longer-term outcomes. METHODS A single-center, retrospective, case-control study was conducted for patients undergoing spinal metastasis surgery from February 2010 to January 2021. The primary outcome was receiving a palliative care consultation, and the timing of consultation was divided into same hospital stay consultation, preoperative versus postoperative consultation, and early ( RESULTS Of 363 patients undergoing surgery for spinal metastasis, 62 (17.0%) patients received palliative care consultation during the same hospitalization, 11 (17.7%) were preoperative, and 51 (82.2%) were postoperative. Among same-stay consultations, 32 (51.6%) were early and 30 (48.4%) were late. Palliative care consultation recipients had worse preoperative Karnofsky Performance Scale (KPS) score (P < 0.001), were more likely to have other organ metastases (P = 0.005) or cord compression (P = 0.026), had longer hospitalization (P < 0.001), and were less likely to be discharged home (P < 0.001). Patients presenting with mechanical pain were more likely to receive preoperative consults compared with postoperative (P = 0.029), and earlier compared with later consultations (P = 0.046). Regarding long-term outcomes, patients with same-stay palliative care consultation had significantly shorter overall survival (log-rank; P < 0.001), worse KPS postoperatively (P = 0.017), and worse KPS and Modified McCormick Scale at the last follow-up (P < 0.001). CONCLUSIONS Only 1 in 6 patients received palliative care consultation. Patients receiving same-stay palliative care consultation had more advanced local and systemic disease burden. Increased utilization of palliative care consultation in patients with spine metastasis is needed.
Collapse
Affiliation(s)
- Jeffrey W Chen
- Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Mohana B Karlekar
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| |
Collapse
|
2
|
Li Y, Ran G, Chen K, Shen X. Preoperative Psychological Burdens in Patients with Vestibular Schwannoma. Ann Otol Rhinol Laryngol 2021; 131:239-243. [PMID: 34032139 DOI: 10.1177/00034894211018915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess preoperative psychological burden in patients with vestibular schwannoma (VS). METHODS A total of 100 patients undergoing VS resection between September 2019 and June 2020 completed preoperative psychological screening. The Hospital Anxiety and Depression Scale (HADS) was applied the day before surgery, and a score >14 was considered clinically important. Univariate and multivariate logistic regression analyzes were used to identify risk factors associated with increased preoperative psychological stress. RESULTS Of the 100 patients who underwent VS resection, 44% were male, with a mean age of 45.9 years. Twenty-two (22%) had HADS scores >14. For the univariate analysis, risk factors associated with elevated psychological burden included time since diagnosis, number of symptoms, headache, vertigo, and nausea and/or vomiting. In the regression analysis, the number of symptoms and greater time from diagnosis to treatment correlated with higher preoperative psychological stress. CONCLUSION Nearly 1 in 4 patients with VS experienced clinically significant emotional burden preoperatively. Number of symptoms and greater time from diagnosis to treatment contributed to this psychological burden.
Collapse
Affiliation(s)
- Yufeng Li
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Guo Ran
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Kaizheng Chen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xia Shen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Kavya S, Reghu R. An Overview of High-grade Glioma: Current and Emerging Treatment Approaches. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394716666200721155514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
High grade glioma is one of the severe form of tumour that progresses in the glial cells
of the brain and spinal cord. Age, gender, exposure to infections, race, ethnicity, viruses and allergens,
environmental carcinogens, diet, head injury or trauma and ionizing radiation may report
with increased glioma risk. Headache, seizure mainly generalized tonic-clonic seizure, memory
loss and altered sensorium are considered as common symptoms of glioma. Magnetic Resonance
Imaging (MRI), CT scans, neurological examinations and biopsy are considered as the diagnostic
option for glioma. Treatment for glioma mainly depended upon the tumour progression, malignancy,
cell type, age, location of tumour growth and anatomic structure. The standard treatment includes
surgery, radiation therapy and chemotherapy. Temozolomide is usually prescribed at a
dosage of 75 mg/m2 and began in combination with radiation therapy and continued daily. The primary
indicator of hepatotoxicity is the elevation of the liver profiles, i.e. the changes in any of the
liver panels may be considered to be hepatotoxic. Serum glutamic oxaloacetic transaminase (SGOT),
Serum Glutamic Pyruvic Transaminase (SGPT), Alkaline phosphatase (ALP) are rising panels
of the liver, which are elevated during toxicity. In some patients, albumin and globulin levels
may show variations. Treatment for glioma associated symptoms like seizures, depression anxiety
etc. are also mentioned along with supportive care for glioma. New trends in the treatment for glioma
are RINTEGA, an experimental immunotherapeutic agent and bevazizumab, a recombinant
monoclonal, a humanized antibody against the VEGF ligand [VEGF-A (vascular endothelial
growth factor)] in tumor cells.
Collapse
Affiliation(s)
- S.G. Kavya
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, 682041, Kerala, India
| | - R. Reghu
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, 682041, Kerala, India
| |
Collapse
|
4
|
Acute palliative care unit-initiated interventions for advanced cancer patients at the end of life: prediction of impending death based on Glasgow Prognostic Score. Support Care Cancer 2020; 29:1557-1564. [PMID: 32734391 DOI: 10.1007/s00520-020-05638-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Unexpected death occurred in an unexpectedly high proportion of advanced cancer patients in the acute palliative care unit (APCU) setting and associated with fewer signs of impending death. Recognition of patients at high risk of approaching death, especially immediately after admitting APCU among clinicians, can improve the end-of-life trajectory. Our objective was accurate prognostication within a few days of admission. METHODS Patients admitted to an APCU of the NTT Medical Center Tokyo, Tokyo, Japan, between April 2009 and December 2016 were retrospectively examined. The Glasgow Prognostic Score (GPS) was optimized with concomitant neutrophilia, lymphocytopenia, thrombocytopenia, anemia, and monocytosis. Kaplan-Meier survival curves were estimated, and independent predictors for 3-day mortality were identified using univariate and multivariate analyses. The sensitivity, specificity, and likelihood ratios (LRs) associated with imminent death were also assessed. RESULTS Nine hundred ninety-one patients were included; 52.9% was male. The median age was 72 years. The median survival was 13 days (IQ range 6 to 26), and 11.7% died within 3 days of admission. Significant difference in survival with a GPS of 2 was observed in GPS optimized with concomitant thrombocytopenia, and it was the only significant predictor associated with 3-day mortality (p = 0.004), which had high specificity (> 95%) and high positive LR (> 5). CONCLUSION The prognostic value of the GPS was enhanced by adding thrombocytopenia. The concurrent use of the GPS and platelet count improved the prognostication of limited time of survival and could assist in the personal and clinical decisions for advanced cancer patients.
Collapse
|
5
|
Baba A, McCradden MD, Rabski J, Cusimano MD. Determining the unmet needs of patients with intracranial meningioma-a qualitative assessment. Neurooncol Pract 2020; 7:228-238. [PMID: 32626591 PMCID: PMC7318855 DOI: 10.1093/nop/npz054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meningiomas are the most common primary benign brain neoplasms, but despite their commonality, the supportive needs of this patient population have been overlooked. The aim of this study is to identify unmet needs of meningioma patients, caregivers, and health care providers. METHODS We adopted a patient-centered approach by using qualitative interviewing with patients diagnosed with a meningioma who have undergone treatment in the last 10 years since the date of their interview. Informal caregivers (family and/or friends) of the patient population and health care providers who are normally involved in the management and care of meningioma patients were also interviewed. Interview transcripts were subjected to thematic analysis. RESULTS Of the 50 participants interviewed, there were 30 patients, 12 caregivers, and 8 health care professionals. Thematic analysis revealed 4 overarching themes: (1) access to targeted postoperative care, (2) financial struggles for patients and their families, (3) lack of information specific to meningiomas and postsurgical management, and (4) lack of psychosocial support. CONCLUSION This study identified supportive needs specific to the meningioma patient population, which predominantly falls within the postoperative phase. The postoperative journey of this patient population could potentially extend to the rest of the patient's life, which necessitates resources and information directed to support postoperative recovery and management. The development of directly relevant supportive resources that support meningioma patients in their postoperative recovery is necessary to improve the health-related quality of life in this patient population.
Collapse
Affiliation(s)
- Ami Baba
- Injury Prevention Research Office, St. Michael’s Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Melissa D McCradden
- Injury Prevention Research Office, St. Michael’s Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Jessica Rabski
- Injury Prevention Research Office, St. Michael’s Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Injury Prevention Research Office, St. Michael’s Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| |
Collapse
|
6
|
Guidelines for seizure management in palliative care: proposal for an updated clinical practice model based on a systematic literature review. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
7
|
León Ruiz M, Rodríguez Sarasa M, Sanjuán Rodríguez L, Pérez Nieves M, Ibáñez Estéllez F, Arce Arce S, García-Albea Ristol E, Benito-León J. Guía para el manejo de las crisis epilépticas en cuidados paliativos: propuesta de un modelo actualizado de práctica clínica basado en una revisión sistemática de la literatura. Neurologia 2019; 34:165-197. [DOI: 10.1016/j.nrl.2016.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 01/19/2023] Open
|
8
|
Goebel S, Mehdorn HM. Fear of disease progression in adult ambulatory patients with brain cancer: prevalence and clinical correlates. Support Care Cancer 2019; 27:3521-3529. [PMID: 30684045 DOI: 10.1007/s00520-019-04665-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/17/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Fear of progression (FoP) is frequent in patients with cancer and of high clinical relevance. Despite the often devastating prognosis of brain cancer, FoP has not yet been assessed in neurooncological patients. OBJECTIVE The aim of this study was thus the assessment of FoP and its clinical correlates. METHODS In an ambulatory setting, 42 patients with a primary brain tumour completed the Fear of Progression questionnaire FoP-Q-12. Clinical correlates of FoP were assessed via a variety of measures, including patients' physical state (Karnofsky Performance Status, KPS), cancer-related psychosocial distress (Distress Thermometer, DT), anxiety (General Anxiety Disorder Scale, GAD-7), depression (Patient Health Questionnaire, PHQ-9), Quality of Life (Short Form Health Survey, SF-8), and unmet supportive care needs (Supportive Care Needs Survey, SCNS). RESULTS Eighteen patients (42%) suffered from high FoP (i.e. scored ≥ 34 in the FoP-Q-12). According to the 12 items of the FoP-Q-12, the greatest fears were worrying about what would happen to their family and being afraid of severe medical treatments. No sociodemographic variables (e.g. age, gender) or medical tumour characteristics (e.g. tumour malignancy, first or recurrent tumour) were related to FoP. Patients with more severe physical symptoms reported higher FoP. Patients with higher FoP were more anxious, more depressed, reported lower Quality of Life, and suffered from more unmet supportive care needs. CONCLUSION Our results demonstrate that FoP is frequent and of high clinical relevance for neurooncological patients. Its assessment is not sufficiently covered by instruments for assessment of other areas of psychological morbidity (e.g. general anxiety). Moreover, FoP cannot be predicted by objective characteristics of the patients and disease. Thus, the routine screening for FoP is recommended in neurooncological patients. Clinicians should bear in mind that patients with high FoP are likely to suffer from high emotional distress and unmet supportive care needs and initiate treatment accordingly.
Collapse
Affiliation(s)
- Simone Goebel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Olshausenstraße 62, 24118, Kiel, Germany.
| | | |
Collapse
|
9
|
Yang Y, Mao Q, Wang X, Liu Y, Mao Y, Zhou Q, Luo J. An analysis of 170 glioma patients and systematic review to investigate the association between IDH-1 mutations and preoperative glioma-related epilepsy. J Clin Neurosci 2016; 31:56-62. [PMID: 27406953 DOI: 10.1016/j.jocn.2015.11.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/03/2015] [Accepted: 11/08/2015] [Indexed: 02/05/2023]
Abstract
Seizure is a common presenting symptom of glioma, and many biomarkers have been suggested to be associated with preoperative seizure; however, the relationships between IDH (isocitrate dehydrogenase) mutations and glioma-related epilepsy only recently been studied. The authors aimed to examine the correlations between IDH mutations in glioma patients with preoperative seizures and tumor location. A series of 170 glioma samples were analyzed for IDH1 R132H mutations (amino acid change from arginine to histidine at codon 132) with immunohistochemistry (IHC) staining and for IDH mutations with direct DNA sequencing when the IHC results were negative. If either the IHC or direct DNA sequencing result was positive, the IDH status was defined as mutated. The results of the IDH mutation examinations were used to analyze the relationship between mutations and glioma-related epilepsy. The study population consisted of 64 (37.6%) World Health Organization (WHO) grade II gliomas, 58 (34.1%) grade III, and 48 (28.3%) grade IV gliomas. A total of 84 samples with IDH1 mutations were observed in our study, and 54 of these presented with seizures as the initial symptoms, whereas 28 of the patients with wild-type IDH status presented with seizures (p=0.043 for the WHO grade II gliomas, p=0.002 for the grade III gliomas and p=0.942 for the grade IV gliomas, chi-squared tests). Among the WHO grade II and III gliomas, IDH1 mutations were significantly associated with preoperative seizures, but no significant relationship between IDH mutations and preoperative seizures was found with glioblastoma multiforme.
Collapse
Affiliation(s)
- Yuan Yang
- Department of Neurosurgery, Waiguoxuexiang No. 37, West China Hospital, Si Chuan University, Chengdu 610041, Sichuan Province, China
| | - Qing Mao
- Department of Neurosurgery, Waiguoxuexiang No. 37, West China Hospital, Si Chuan University, Chengdu 610041, Sichuan Province, China.
| | - Xiang Wang
- Department of Neurosurgery, Waiguoxuexiang No. 37, West China Hospital, Si Chuan University, Chengdu 610041, Sichuan Province, China
| | - Yanhui Liu
- Department of Neurosurgery, Waiguoxuexiang No. 37, West China Hospital, Si Chuan University, Chengdu 610041, Sichuan Province, China
| | - Yunhe Mao
- West China Medical School of Si Chuan University, Chengdu 610041, Sichuan Province, China
| | - Qiao Zhou
- Department of Neuropathology, West China Hospital, Si Chuan University, Chengdu 610041, Sichuan Province, China
| | - Jiewen Luo
- Department of Neurosurgery, Waiguoxuexiang No. 37, West China Hospital, Si Chuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
10
|
Kos N, Kos B, Benedicic M. Early medical rehabilitation after neurosurgical treatment of malignant brain tumours in Slovenia. Radiol Oncol 2016; 50:139-44. [PMID: 27247545 PMCID: PMC4852966 DOI: 10.1515/raon-2015-0004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/03/2014] [Indexed: 11/18/2022] Open
Abstract
Background The number of patients with malignant brain tumours is on the rise, but due to the novel treatment methods the survival rates are higher. Despite increased survival the consequences of tumour properties and treatment can have a significant negative effect on the patients’ quality of life. Providing timely and appropriate rehabilitation interventions is an important aspect of patient treatment and should be started immediately after surgery. The most important goal of rehabilitation is to prevent complications that could have a negative effect on the patients’ ability to function. Conclusions By using individually tailored early rehabilitation it is often possible to achieve the patients’ independence in mobility as well as in performing daily tasks before leaving the hospital. A more precise evaluation of the patients’ functional state after completing additional oncologic therapy should be performed to stratify the patients who should be directed to complex rehabilitation treatment. The chances of a good functional outcome in patients with malignant brain tumours could be increased with good early medical rehabilitation treatment.
Collapse
Affiliation(s)
- Natasa Kos
- Medical Rehabilitation Unit, University Medical Centre, Ljubljana, Slovenia
| | - Boris Kos
- Zdravstveni dom dr. Julija Polca Kamnik, Slovenia
| | - Mitja Benedicic
- Department of Neurosurgery, University Medical Centre, Ljubljana, Slovenia
| |
Collapse
|
11
|
Zhou T, Wang CH, Yan H, Zhang R, Zhao JB, Qian CF, Xiao H, Liu HY. Inhibition of the Rac1-WAVE2-Arp2/3 signaling pathway promotes radiosensitivity via downregulation of cofilin-1 in U251 human glioma cells. Mol Med Rep 2016; 13:4414-20. [PMID: 27052944 DOI: 10.3892/mmr.2016.5088] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 03/16/2016] [Indexed: 11/05/2022] Open
Abstract
The Ras-related C3 botulinum toxin substrate 1 (Rac1)-WASP-family verprolin-homologous protein-2 (WAVE2)-actin-related protein 2/3 (Arp2/3) signaling pathway has been identified to be involved in cell migration and invasion in various types of cancer cell. Cofilin‑1 (CFL‑1), which is regulated by the Rac1‑WAVE2‑Arp2/3 signaling pathway, may promote radioresistance in glioma. Therefore, the present study aimed to investigate the potential role of the Rac1‑WAVE2‑Arp2/3 signaling pathway in radioresistance in U251 human glioma cells and elucidate its affect on CFL‑1 expression. Western blot analysis was performed to evaluate the protein expression of CFL‑1. In the present study, Rac1 was inhibited by NSC 23766, WAVE2 was inhibited by transfection with short hairpin (sh)RNA‑WAVE2 using Lipofectamine™ 2000 and Arp2/3 was inhibited by CK‑666. Cell viability was measured using the 3‑(4,5‑dimethylthiazol‑2‑yl)-2,5‑diphenyltetrazolium bromide assay, the cell migration ability was examined by a wound‑healing assay, and the cell invasion ability was assessed using a Transwell culture chamber system. The results showed that inhibition of the Rac1‑WAVE2‑Arp2/3 signaling pathway using NSC 23766, shRNA‑WAVE2 or CK‑666 reduced the cell viability, migration and invasion abilities in U251 human glioma cells, concordant with a reduced expression of CFL‑1. Furthermore, the expression of CFL‑1 was significantly increased in radioresistant U251 glioma cells when compared with normal U251 human glioma cells. These findings indicate that inhibition of the Rac1‑WAVE2‑Arp2/3 signaling pathway may promote radiosensitivity, which may partially result from the downregulation of CFL‑1 in U251 human glioma cells.
Collapse
Affiliation(s)
- Tao Zhou
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Chen-Han Wang
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Hua Yan
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Rui Zhang
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Jin-Bing Zhao
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Chun-Fa Qian
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Hong Xiao
- Neuropsychiatric Institute, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Hong-Yi Liu
- Department of Neurosurgery, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, P.R. China
| |
Collapse
|
12
|
Abstract
The end-of-life (EOL) phase of patients with a glioma starts when symptom prevalence increases and antitumor treatment is no longer effective. During the EOL phase, care is primarily aimed at reducing symptom burden while maintaining quality of life as long as possible without inappropriate prolongation of life. Palliative care during the EOL phase also involves complex medical decisions for the prevention and relief of suffering. We discuss the prevalence and treatment of the most common EOL symptoms, decision making in the EOL phase, the organization of EOL care, and the role of the patient's caregiver. Treating disease-specific symptoms, such as impaired consciousness, seizures, focal neurologic deficits and cognitive disturbances, is a major concern during the EOL phase, as these symptoms may interfere with EOL decision making. Advance care planning is aimed at reaching consensus about possible EOL decisions between all participants, respecting the values of patients and their informal caregivers. In order to prevent the possibility that the patient becomes incompetent to make informed decisions, we recommend initiating EOL conversations at a relatively early stage in the disease course.
Collapse
|
13
|
Thier K, Calabek B, Tinchon A, Grisold W, Oberndorfer S. The Last 10 Days of Patients With Glioblastoma: Assessment of Clinical Signs and Symptoms as well as Treatment. Am J Hosp Palliat Care 2015; 33:985-988. [PMID: 26472939 DOI: 10.1177/1049909115609295] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND High-grade gliomas are the most frequent primary brain tumors. Despite improvement in diagnostics and treatment, survival is still poor and quality-of-life issues are of major importance. Little is known regarding the clinical signs and symptoms of dying patients with glioblastoma. OBJECTIVE The aim of this study was to investigate signs and symptoms as well as therapeutic strategies in patients with glioblastoma in the end-of-life phase in order to improve end-of-life care. METHODS In this prospective single-center study, clinical data were obtained using a standardized protocol. We descriptively analyzed signs, symptoms, and therapeutic strategies on a daily basis. RESULTS A total of 57 patients, who died due to glioblastoma in a hospital setting, were included. The most frequent signs and symptoms in the last 10 days before death were decrease in level of consciousness (95%), fever (88%), dysphagia (65%), seizures (65%), and headache (33%). Concerning medication, 95% received opioids. There was a high need for nonsteroidal anti-inflammatory drugs (77%) and anticonvulsants (75%). Steroids were given to 56%. CONCLUSION Due to a decrease in level of consciousness and cognitive impairment, assessment of clinical signs and symptoms such as headache at the end of life is difficult. Based on the signs and symptoms in the last days before death in patients with glioblastoma, supportive drug treatment remains challenging. Our study emphasizes the importance of standardized guidelines for end-of-life care in patients with glioblastoma.
Collapse
Affiliation(s)
- Katrin Thier
- Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria
| | - Bernadette Calabek
- Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria
| | - Alexander Tinchon
- Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria
| | - Wolfgang Grisold
- Department of Neurology, Kaiser-Franz-Josef-Hospital, Vienna, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria
| |
Collapse
|
14
|
Cormie P, Nowak AK, Chambers SK, Galvão DA, Newton RU. The potential role of exercise in neuro-oncology. Front Oncol 2015; 5:85. [PMID: 25905043 PMCID: PMC4389372 DOI: 10.3389/fonc.2015.00085] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/23/2015] [Indexed: 12/24/2022] Open
Abstract
Patients with brain and other central nervous system cancers experience debilitating physical, cognitive, and emotional effects, which significantly compromise quality of life. Few efficacious pharmacological strategies or supportive care interventions exist to ameliorate these sequelae and patients report high levels of unmet needs in these areas. There is strong theoretical rationale to suggest exercise may be an effective intervention to aid in the management of neuro-oncological disorders. Clinical research has established the efficacy of appropriate exercise in counteracting physical impairments such as fatigue and functional decline, cognitive impairment, as well as psychological effects including depression and anxiety. While there is promise for exercise to enhance physical and psychosocial wellbeing of patients diagnosed with neurologic malignancies, these patients have unique needs and research is urgently required to explore optimal exercise prescription specific to these patients to maximize safety and efficacy. This perspective article is a discussion of potential rehabilitative effects of targeted exercise programs for patients with brain and other central nervous system cancers and highlights future research directions.
Collapse
Affiliation(s)
- Prue Cormie
- Edith Cowan University Health and Wellness Institute, Edith Cowan University , Joondalup, WA , Australia
| | - Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia , Nedlands, WA , Australia ; Department of Medical Oncology, Sir Charles Gairdner Hospital , Nedlands, WA , Australia
| | - Suzanne K Chambers
- Edith Cowan University Health and Wellness Institute, Edith Cowan University , Joondalup, WA , Australia ; Griffith Health Institute, Griffith University , Southport, QLD , Australia ; Cancer Council Queensland , Brisbane, QLD , Australia ; Prostate Cancer Foundation of Australia , Sydney, NSW , Australia
| | - Daniel A Galvão
- Edith Cowan University Health and Wellness Institute, Edith Cowan University , Joondalup, WA , Australia
| | - Robert U Newton
- Edith Cowan University Health and Wellness Institute, Edith Cowan University , Joondalup, WA , Australia ; The University of Hong Kong , Hong Kong , China
| |
Collapse
|
15
|
Abstract
Objectives of this review were to examine definitions and background of palliative care, as well as address whether there is an increased need for palliative care education among neurologists. The review also explores what literature exists regarding palliative care within general neurology and child neurology. A literature review was conducted examining use of palliative care within child neurology. More than 100 articles and textbooks were retrieved and reviewed. Expert guidelines stress the importance of expertise in palliative care among neurologists. Subspecialties written about in child neurology include that of peripheral nervous system disorders, neurodegenerative diseases, and metabolic disorders. Adult and child neurology patients have a great need for improved palliative care services, as they frequently develop cumulative physical and cognitive disabilities over time and cope with decreasing quality of life before reaching the terminal stage of their illness.
Collapse
Affiliation(s)
- Alexis Dallara
- New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Anca Meret
- New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - John Saroyan
- BAYADA Hospice, Palliative Care, Norwich, VT, USA
| |
Collapse
|
16
|
Koekkoek JAF, Dirven L, Reijneveld JC, Postma TJ, Grant R, Pace A, Oberndorfer S, Heimans JJ, Taphoorn MJB. Epilepsy in the end of life phase of brain tumor patients: a systematic review. Neurooncol Pract 2014; 1:134-140. [PMID: 31386028 DOI: 10.1093/nop/npu018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 12/13/2022] Open
Abstract
Epileptic seizures are common in patients with primary or secondary malignant brain tumor. However, current knowledge on the occurrence of seizures during the end of life (EOL) phase of brain tumor patients is limited. Because symptom management with preservation of quality of life is of major importance for patients with a malignant brain tumor, particularly in the EOL, it is necessary to gain a deeper understanding of seizures and their management during this phase. We performed a systematic review of literature related to epilepsy in the EOL phase of brain tumor patients, based on the electronic resources PubMed, Embase, and Cinahl. The search yielded 442 unique records, of which 11 articles were eligible for further analysis after applying predefined inclusion criteria. Seizures occur relatively frequently in the EOL phase, particularly in patients with high-grade glioma. However, seizure management is often hampered by swallowing difficulties and impaired consciousness. Treatment decisions are largely dependent on expert opinion because a standardized approach for treating seizures in the terminal stage of brain tumor patients is still lacking.
Collapse
Affiliation(s)
- Johan A F Koekkoek
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Linda Dirven
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Jaap C Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Tjeerd J Postma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Robin Grant
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Andrea Pace
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Stefan Oberndorfer
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Jan J Heimans
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Martin J B Taphoorn
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| |
Collapse
|
17
|
Mummudi N, Jalali R. Palliative care and quality of life in neuro-oncology. F1000PRIME REPORTS 2014; 6:71. [PMID: 25165570 PMCID: PMC4126540 DOI: 10.12703/p6-71] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health-related quality of life has become an important end point in modern day clinical practice in patients with primary or secondary brain tumors. Patients have unique symptoms and problems from diagnosis till death, which require interventions that are multidisciplinary in nature. Here, we review and summarize the various key issues in palliative care, quality of life and end of life in patients with brain tumors, with the focus on primary gliomas.
Collapse
|
18
|
Koekkoek JAF, Dirven L, Sizoo EM, Pasman HRW, Heimans JJ, Postma TJ, Deliens L, Grant R, McNamara S, Stockhammer G, Medicus E, Taphoorn MJB, Reijneveld JC. Symptoms and medication management in the end of life phase of high-grade glioma patients. J Neurooncol 2014; 120:589-95. [DOI: 10.1007/s11060-014-1591-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
|
19
|
Piil K, Juhler M, Jakobsen J, Jarden M. Controlled rehabilitative and supportive care intervention trials in patients with high-grade gliomas and their caregivers: a systematic review. BMJ Support Palliat Care 2014; 6:27-34. [PMID: 24890014 PMCID: PMC4789693 DOI: 10.1136/bmjspcare-2013-000593] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 04/30/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients diagnosed with high-grade gliomas experience a varying and complex symptom burden, and face a high mortality rate. As a consequence, patients with high-grade gliomas and their caregivers have imminent and changing rehabilitative and supportive care needs. OBJECTIVES To give a detailed overview of non-pharmacological rehabilitative and supportive care interventions for patients with high-grade gliomas and/or their caregivers, and provide an appraisal of the methodological quality of these studies. METHOD PubMed, Cumulative Index of Nursing and Allied Health Literature and Embase were searched for literature published from 1995 to May 2013. Data from eight studies were reviewed for substantive methods and results. Methodological quality was described and assessed using the scoring system for appraising mixed methods research and concomitantly appraising qualitative, quantitative and mixed methods primary studies in mixed study reviews. RESULTS The search yielded 914 unique publications, of which 9 were classified eligible for this review. There is preliminary evidence that cognitive group therapy improves memory skills in patients with high-grade gliomas, early physical training improves functional outcome and massage therapy reduces stress. Patients and caregivers found that telephone follow-up and a specialist nurse function was an effective and useful way to achieve information and support. Finally, psycho-education increased feelings of mastery among caregivers. CONCLUSIONS As evidence is beginning to emerge, there is a need for well-designed longitudinal and randomised controlled trials of non-pharmacological interventions in high-grade glioma patients and their caregivers in order to develop clinical guidelines for supportive and rehabilitative approaches in this unique population.
Collapse
Affiliation(s)
- K Piil
- Department of Neurosurgery, The University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation for Patients with Cancer (CIRE), Copenhagen, Denmark
| | - M Juhler
- Department of Neurosurgery, The University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark Department of Clinical Medicine, Section of Neurology, Psychiatry and Sensory Sciences, The University of Copenhagen, Copenhagen K, Denmark
| | - J Jakobsen
- The University Hospital of Copenhagen; Rigshospitalet, Neuroscience Center, Copenhagen, Denmark
| | - M Jarden
- The University Hospitals Center for Health Research (UCSF), Center for Integrated Rehabilitation for Patients with Cancer (CIRE), Copenhagen, Denmark
| |
Collapse
|
20
|
Pace A, Villani V, Di Pasquale A, Benincasa D, Guariglia L, Ieraci S, Focarelli S, Carapella CM, Pompili A. Home care for brain tumor patients. Neurooncol Pract 2014; 1:8-12. [PMID: 26034609 DOI: 10.1093/nop/npt003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 11/26/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Brain tumor patients are quite different from other populations of cancer patients due to the complexity of supportive care needs, the trajectory of disease, the very short life expectancy, and resulting need for a specific palliative approach. METHODS A pilot program of comprehensive palliative care for brain tumor patients was started in the Regina Elena National Cancer Institute of Rome in October 2000, supported by the Lazio Regional Health System. The aim of this model of assistance was to meet patient's needs for care in all stages of disease, support the families, and reduce the rehospitalization rate. The efficacy of the model of care was evaluated analyzing the place of death, caregiver satisfaction, rehospitalization rate, and the impact on costs to the health system. RESULTS From October 2000 to December 2012, 848 patients affected by brain tumor were enrolled in a comprehensive program of neuro-oncological home care. Out of 529 patients who died, 323 (61%) were assisted at home until death, 117 (22.2%) died in hospital, and 89 (16.8%) died in hospice. A cost-effectiveness analysis demonstrated a significant reduction in hospital readmission rates in the last 2 months of life compared with the control group (16.7% vs 38%; P < .001). CONCLUSIONS Our findings concerning death at home, rehospitalization rate, quality of life, and satisfaction of patients and their relatives with the care received suggest that a neuro-oncologic palliative home-care program has a positive impact on the quality of care for brain tumor patients, particularly at the end of life.
Collapse
Affiliation(s)
- Andrea Pace
- Department of Neuroscience , Regina Elena National Cancer Institute , Rome , Italy
| | - Veronica Villani
- Department of Neuroscience , Regina Elena National Cancer Institute , Rome , Italy
| | | | - Dario Benincasa
- Department of Neuroscience , Regina Elena National Cancer Institute , Rome , Italy
| | - Lara Guariglia
- Department of Neuroscience , Regina Elena National Cancer Institute , Rome , Italy
| | - Sonia Ieraci
- Department of Neuroscience , Regina Elena National Cancer Institute , Rome , Italy
| | - Silvia Focarelli
- Department of Neuroscience , Regina Elena National Cancer Institute , Rome , Italy
| | | | - Alfredo Pompili
- Department of Neuroscience , Regina Elena National Cancer Institute , Rome , Italy
| |
Collapse
|
21
|
Sizoo EM, Grisold W, Taphoorn MJB. Neurologic aspects of palliative care: the end of life setting. HANDBOOK OF CLINICAL NEUROLOGY 2014; 121:1219-1225. [PMID: 24365413 DOI: 10.1016/b978-0-7020-4088-7.00081-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
As there are, to date, few curative treatment options for many neurologic diseases, end of life (EOL) care is an important aspect of the treatment of neurologic patients. In the EOL phase, treatment should be aimed at relieving symptoms, maintaining quality of life, and facilitating a peaceful and dignified way of dying. Common signs and symptoms in the EOL phase of neurologic patients are raised intracranial pressure, seizures, confusion, cognitive deficits, and impaired motor function. Supportive treatment of these symptoms (such as analgesic drugs, dexamethasone, antiepileptic and neuroleptic drugs) is of major importance to maintain quality of life as long as possible. Another key aspect of EOL care is EOL decision making, such as withholding or withdrawing life-sustaining treatment, and palliative sedation. The main goal of EOL decision making is the prevention and relief of suffering, even if this might hasten death. Especially in advanced stages of many neurologic diseases, confusion, cognitive deficits, communication deficits, and decreasing levels of consciousness may impair the competence of patients to participate in EOL decision making. Given that patient autonomy is increasingly essential, advance care planning (ACP) at an early stage of the disease should be considered.
Collapse
Affiliation(s)
- Eefje M Sizoo
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josep Hospital, Vienna, Austria
| | | |
Collapse
|
22
|
Schneck MJ. Venous thromboembolism in neurologic disease. HANDBOOK OF CLINICAL NEUROLOGY 2013; 119:289-304. [PMID: 24365303 DOI: 10.1016/b978-0-7020-4086-3.00020-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with neurologic disease are at high risk of venous thromboembolism (VTE) because of relative immobility. They are also at increased risk due to the presence of a hypercoagulable state. Patients with spinal cord injuries, brain tumors, and strokes are at particularly high risk and extra vigilance is needed in these patients. Because VTE is very common in hospitalized neurologic and neurosurgical patients, mechanical thromboprophylaxis is indicated in virtually all patients. Pharmacologic prophylaxis with either subcutaneous heparin or low molecular heparinoids should be given to all high-risk neurologic and neurosurgical patients provided there are no major contraindications. The major concern would be a risk of bleeding but in some patients alternate drugs must be considered given the risk of thrombosis (i.e., in the context of heparin-induced thrombocytopenia). The immediate or long-term treatment of full dose anticoagulation for VTE may not be appropriate in all patients as VTE therapy represents a balance between the risks of bleeding related to anticoagulant therapy versus the risk of recurrent events. An inferior vena cava (IVC) filter is another option in these patients but may not necessarily be the best choice for most neurologic patients. Given the high risk of VTE in patients with neurologic diseases, early recognition by clinicians of the signs and symptoms of VTE is essential.
Collapse
Affiliation(s)
- Michael J Schneck
- Departments of Neurology and Neurosurgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
| |
Collapse
|
23
|
Kanter C, D'Agostino NM, Daniels M, Stone A, Edelstein K. Together and apart: providing psychosocial support for patients and families living with brain tumors. Support Care Cancer 2013; 22:43-52. [PMID: 23989499 DOI: 10.1007/s00520-013-1933-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 08/05/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Brain tumors are associated with neurological sequelae and poor survival, contributing to distress in patients and their families. Our institution has conducted separate support groups for brain tumor patients and caregivers since 1999. This retrospective cohort study aimed to identify characteristics of brain tumor group participants in relation to attendance frequency, and compare themes of discussion in patient and caregiver groups. METHODS Demographic and medical characteristics were obtained from patient and caregiver group registration sheets and medical chart review. We quantified discussion topics recorded by group facilitators between 1999 and 2006, extracted themes, and examined similarities and differences in the way these themes were expressed. RESULTS A total of 137 patients and 238 caregivers attended the groups; about half attended more than one session. The chart review of a randomly selected subset of patient participants revealed that 57.5 % were married, 58.8 % had high-grade gliomas, and 55 % attended their first group within 3 months of diagnosis or at tumor progression. Both groups discussed physical and cognitive consequences, emotional reactions, relationships, coping, end of life, and practical issues. Caregivers discussed difficulties achieving self-care and caregiver burden. CONCLUSIONS Brain tumor support group facilitators can expect to encounter a range of medical and psychosocial issues in accommodating patients' and caregivers' diverse concerns. Separate brain tumor patient and caregiver groups may allow participants to explore those concerns without worrying about effects on their friends or family. It remains to be seen whether the groups meet the needs of attendees, and whether those who do not attend the groups have unmet needs.
Collapse
Affiliation(s)
- Cheryl Kanter
- Pencer Brain Tumor Centre, Princess Margaret Cancer Centre, 610 University Ave Room 18-714, Toronto, ON, M5G 2M9, Canada,
| | | | | | | | | |
Collapse
|
24
|
Heese O, Vogeler E, Martens T, Schnell O, Tonn JC, Simon M, Schramm J, Krex D, Schackert G, Reithmeier T, Nikkhah G, Sabel M, Steiger HJ, Schlegel U, Löffler M, Weller M, Westphal M. End-of-life caregivers' perception of medical and psychological support during the final weeks of glioma patients: a questionnaire-based survey. Neuro Oncol 2013; 15:1251-6. [PMID: 23814266 DOI: 10.1093/neuonc/not089] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The prognosis for glioma remains dismal, and little is known about the final disease phase. To obtain information about this period, we surveyed caregivers of patients who were registered in the German Glioma Network and who died from the disease. METHODS A questionnaire with 15 items, focusing on medical, logistic, and mental health support and symptom control during the final 4 weeks, was sent to caregivers. For some of the questions, a scale from 1 (inadequate) to 10 (excellent) was used. RESULTS Of 1655 questionnaires, 605 were returned (36.6%) and evaluated. We found that 67.9% of the patients were taken care of at home for the last 4 weeks; 47.7% died at home, 22.6% died in hospitals, and 19.3% died in hospice facilities. Medical support was provided by general practitioners in 72.3% of cases, by physicians affiliated with a nursing home or hospice in 29.9%, and by general oncologists in 17%. Specialized neuro-oncologists were involved in 6%. The caregivers ranked the medical support with a mean of 7.2 (using a 10-point scale), nursing service with 8.1, and mental health support with 5.5. In 22.9% of cases, no support for the caregivers themselves was offered by medical institutions. CONCLUSIONS Although these data reflect the caregivers' subjective views, they are useful in understanding and improving current patterns of care. While patients and their caregivers are supported mainly by neuro-oncologists for most of the disease phase, the end-of-life phase is managed predominantly by general practitioners and specialists in palliative care. Close cooperation between these specialties is necessary to meet the specific needs of glioma patients.
Collapse
Affiliation(s)
- Oliver Heese
- Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Moore G, Collins A, Brand C, Gold M, Lethborg C, Murphy M, Sundararajan V, Philip J. Palliative and supportive care needs of patients with high-grade glioma and their carers: a systematic review of qualitative literature. PATIENT EDUCATION AND COUNSELING 2013; 91:141-153. [PMID: 23218925 DOI: 10.1016/j.pec.2012.11.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 10/23/2012] [Accepted: 11/04/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Patients diagnosed with primary malignant glioma (PMG) face substantial challenges with poor prognosis, high symptom burden and care needs. This study aims to collate current literature detailing the supportive and palliative care needs of patients with PMG and their carers, and to subject it to a novel approach of formal evaluation. METHODS Medline, EMBASE, CINAHL, PsychInfo were searched with core concepts: (1) glioma, (2) high-grade disease, and (3) palliative and supportive care needs. A narrative synthesis approach was undertaken including a quality appraisal of the 21 included studies. RESULTS Key themes related to the need for consistent well-delivered information around disease sequelae, treatment, and resources available; health service needs including a key professional identified to coordinate care; the need for psychological and social supports, and clear avenues of communication with treating professionals. CONCLUSION The literature remains limited in the number and quality of evidence with two level I, eight level II, and eleven level III studies. The findings call for improved information, communication and support practices to address the complexity and breadth of needs. PRACTICE IMPLICATIONS Specialised and individually tailored information, attention to clear, consistent communication and support practices should be incorporated into a future needs-based model of care.
Collapse
Affiliation(s)
- Gaye Moore
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia
| | | | | | | | | | | | | | | |
Collapse
|
26
|
The impact of a high-grade glioma on everyday life: A systematic review from the patient’s and caregiver’s perspective. Eur J Oncol Nurs 2013; 17:107-17. [PMID: 22658206 DOI: 10.1016/j.ejon.2012.04.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 04/13/2012] [Accepted: 04/28/2012] [Indexed: 11/23/2022]
|
27
|
Porzio G, Aielli F, Verna L, Martella F, Capannolo C, Palma A, Aloisi P, Ficorella C. Is there a role for neurologist in an oncological home care team? Neurol Sci 2013; 34:115-6. [DOI: 10.1007/s10072-012-0945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 01/09/2012] [Indexed: 10/14/2022]
|
28
|
Development of anxiety and depression in patients with benign intracranial meningiomas: a prospective long-term study. Support Care Cancer 2012; 21:1365-72. [PMID: 23238654 DOI: 10.1007/s00520-012-1675-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/26/2012] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to provide the first prospective longitudinal assessment of anxiety and depression in patients with a benign intracranial meningioma (WHO° I). METHODS The Hospital Anxiety and Depression Scale was applied prior to (t1) and directly after (t2) neurosurgery as well as 6 months after surgery (t3). The research was conducted in a single treatment centre in Germany. Numerous sociodemographic, medical, psychological and cognitive accompanying measures were assessed. The study population consisted of 52 meningioma patients. Additionally, a control group of 24 patients with malignant brain tumours (astrocytoma WHO° III) was assessed. RESULTS In meningioma patients, anxiety was high prior to surgery but declined significantly after successful neurosurgical treatment. Low levels of depression were observed at all times. In contrast, astrocytoma patients showed constantly high levels of anxiety whilst depression increased over the course of the disease. Numerous medical, psychosocial and psychological factors were associated with psychiatric morbidity in meningioma patients. CONCLUSIONS In conclusion, psychiatric morbidity of patients with benign intracranial meningiomas was comparable to that of the general population after successful neurosurgical treatment. Numerous associated factors suggest complex relationships within a biopsychosocial model. However, due to the small sample size and recruitment in a single institution, our results are of limited generalisability and need cross-validation in future studies.
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW Patients with brain tumors require close attention to medical issues resulting from their disease or its therapy. Effective medical management results in decreased morbidity and mortality and improved quality of life. The most frequent neurology-related issues that arise in these patients include seizures, peritumoral edema, venous thromboembolism, fatigue, and cognitive dysfunction. This article focuses on the most recent findings for the management of the most relevant medical complications among patients with brain tumors. RECENT FINDINGS Increasing evidence suggests that anticoagulation in patients with thromboembolic complications is safe even when they are receiving antiangiogenic therapy. There are also increasing data to support the use of newer, non-enzyme-inducing antiepileptic drugs, which have the advantage of lacking interactions with antineoplastic agents and are as effective as their older counterparts at preventing seizures. Relatively few studies have addressed the management of fatigue and depression, and definitive recommendations cannot be made. SUMMARY Corticosteroids to treat vasogenic edema should be used at the minimum amount required to control symptoms and should be tapered as quickly as possible. Anticonvulsants should be used only if patients have had seizures. Non-enzyme-inducing antiepileptic drugs are preferred to minimize interactions with concurrently administered chemotherapy. Thromboembolic complications are common and are preferably treated with low-molecular-weight heparins. Only patients with hemorrhagic complications require an inferior vena cava filter. Cognitive deficits are frequent in patients with brain tumors and include problems such as poor short-term memory, distractibility, personality change, emotional lability, loss of executive function, and decreased psychomotor speed. Stimulants can help to improve these symptoms.
Collapse
Affiliation(s)
- Jan Drappatz
- University of Pittsburgh, Pennsylvania 15232, USA.
| |
Collapse
|
30
|
Abstract
Infections represent a serious and frequent complication in neuro-oncology patients. Decreased immune defences, along with poor nutritional status are the main predisposition factors. The combined therapeutic strategies of chemotherapy and radiotherapy may favour bone marrow depression and further increase the risk of developing opportunistic infections in brain tumour patients. The spectrum of infections in neuro-oncology patients is large and includes opportunistic infections by bacteria, viruses, fungi and parasites. Importantly, a high index of suspicion for opportunistic infections in general should be maintained, especially in glioma patients receiving dose-dense schedules of temozolomide. After neurosurgical procedures, infections most commonly present as meningitis, subdural empyema, or cerebral abscess. Infections represent a frequent and possibly serious complication in general immunocompromised oncology population. It should be underlined that infections are not limited to immunocompromised patients, being also present at the early disease stages, especially due to therapeutic strategies (chemo and radiotherapy, surgical procedures). Therefore this issue deserves more attention in neuroncology setting.
Collapse
|
31
|
Gofton TE, Graber J, Carver A. Identifying the palliative care needs of patients living with cerebral tumors and metastases: a retrospective analysis. J Neurooncol 2012; 108:527-34. [DOI: 10.1007/s11060-012-0855-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
|
32
|
Decision-making in the end-of-life phase of high-grade glioma patients. Eur J Cancer 2011; 48:226-32. [PMID: 22153216 DOI: 10.1016/j.ejca.2011.11.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/03/2011] [Accepted: 11/07/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND During the disease course of high-grade glioma (HGG) patients, the goal of therapy eventually shifts from primarily life-prolongation to primarily sustaining the quality of life as good as possible. End-of-life care is aimed at prolongation of life with good quality, but inevitably also may require medical decisions for prevention and relief of suffering with a potential life shortening effect. Few data are available on this end-of-life decision (ELD) making process in HGG patients, with decreased consciousness, confusion or cognitive deficits preventing them to participate. In this study the ELD-making process in HGG patients is described. METHODS Physicians and relatives of a cohort of 155 deceased HGG patients were identified to fill in a questionnaire regarding the end-of-life conditions (patients' ELD preferences, patients' competence) and ELD-making (forgoing treatment and the administration of drugs with a potential life-shortening effect) for their patient or relative. Data were analysed with descriptive statistics. FINDINGS Of 101 patients, physicians completed surveys including questions about ELDs (62% response rate). More than half of the patients relatively early became incompetent to make decisions due to delirium, cognitive deficits and/or decreasing consciousness. In 40% of patients the physician did not discuss ELD preferences with his/her patient. At least one ELD was made in 72% of patients, most often this comprised the withdrawal of dexamethasone. Palliative sedation was performed in 30% of patients and physician assisted death in 7%. INTERPRETATION ELDs are common practises amongst HGG patients, although their preferences towards ELDs are frequently unknown to the physician. Because the majority of patients become incompetent towards death, participation in ELD-making is only possible with advanced care planning. Hence, timely discussion of ELD preferences is encouraged.
Collapse
|
33
|
Taillandier L, Blonski M, Darlix A, Hoang Xuan K, Taillibert S, Cartalat Carel S, Piollet I, Le Rhun E. Supportive care in neurooncology. Rev Neurol (Paris) 2011; 167:762-72. [DOI: 10.1016/j.neurol.2011.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 08/12/2011] [Indexed: 11/29/2022]
|
34
|
Abstract
OPINION STATEMENT Patients with brain tumors require meticulous attention to medical issues resulting from their disease or its therapy. The following specific issues are the ones most frequently arising in the purview of neurologists: (1) Vasogenic edema: Corticosteroids should be used in divided doses in the minimum amount required to control symptoms and should be tapered as quickly as possible. Some patients may require long-term steroid supplementation, and symptoms of adrenal insufficiency should be investigated with 8 AM: cortisol measurement and treated with appropriate repletion. (2) Seizures: Patients with brain tumors should receive antiepileptic drugs only if they have had seizures, and the drugs should be chosen to minimize cognitive effects and interactions with concurrently administered chemotherapy. Levetiracetam is an excellent choice for patients with partial seizures and is available both orally and parenterally. Lamotrigine is another reasonable choice but requires slow titration. (3) Venous thromboembolism: All brain tumor patients should receive perioperative venous thrombosis prophylaxis with compression boots and enoxaparin or dalteparin. Lifelong treatment with low molecular weight heparinoids or warfarin is required for those developing venous thromboembolism. (4) Other problems: Long-term survivors of brain tumors should be monitored indefinitely for cognitive problems, endocrine dysfunction, and development of secondary neoplasms. Modafinil can improve mood and attention impairments.
Collapse
|
35
|
Abstract
Due to the uncertainty of the course of diagnoses, patients with neuro-oncological malignancies present challenges to the physical therapist. At times, the presentation of impairments and disabilities of these patients with neuro-oncological diagnoses do not necessarily coincide with the involved area of the brain or spinal cord. It is our intention to provide guidance to the physical therapist who will be working with these patients with neuro-oncological diagnoses, in hopes that their encounters will be more productive and meaningful. This article describes a brief overview of common central nervous system malignancies, its medical treatment, as well as possible complications and side effects that would need to be considered in rehabilitating these patients. Special consideration is given to the elderly patients with neuro-oncological diagnoses. Pertinent physical therapy assessments and interventions are discussed.
Collapse
Affiliation(s)
- Willie Ching
- Staff Physical Therapist, Department of Health and Human Services, National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Physical Therapy Section, Bethesda, Maryland
| | - Melissa Luhmann
- Staff Physical Therapist, Department of Health and Human Services, National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Physical Therapy Section, Bethesda, Maryland
| |
Collapse
|