Palliative Care in Primary and Metastatic Brain Tumors

Abstract

Introduction: Early palliative care interventions and structured advance care planning can improve symptom control and quality of life in patients with a brain tumor. In this study, we aimed to investigate symptoms, hospital discharge conditions, and the length of stay of patients with primary and metastatic brain tumors in our palliative care center (PCC). Material and Method: Ninety-one patients; who had been followed-up in the PCC with the diagnosis of a primary or metastatic brain tumor were included in this retrospective study. Demographic characteristics, Glasgow Coma Scale (GCS) scores, Karnofsky Performance Scale (KPS) scores, hospital discharge status, and symptoms of the patients included in the study were compared. Results: The mean age of the patients was 60.67 years; 59.3% were male, and the mean length of hospital stay was 29.26 days. The rates of PEG, tracheostomy, seizures, and paresis symptoms were significantly higher in patients with a primary brain tumor (p<0.05). The rates of death in the hospital were significantly higher in patients with metastatic tumors and low GCS scores (p=0.032 and p=0.00, respectively). Conclusion: We observed differences in clinical findings and prognoses between primary and metastatic brain tumor patients during the follow-up in PCC. Further to advances in treatment methods, we believe that identifying the need for palliative care and appropriate symptom management will improve the quality of life in brain tumor patients with poor prognosis.

Keywords

• : Brain tumors
• palliative care
• discharge status
• seizure

Primer ve Metastazik Beyin Tümörlerinde Palyatif Bakım

Abstract

Giriş: Erken Palyatif bakım müdahaleleri ve yapılandırılmış ileri bakım planlaması, beyin tümörü hastalarında semptom kontrolünü ve yaşam kalitesini artırabilir. Bu çalışmada palyatif bakım merkezimizde (PBM) primer ve metastatik beyin tümörü tanısı alan hastaların semptomlarını, çıkış durumlarını ve yatış sürelerini araştırmayı amaçladık. Gereç ve Yöntem: Bu retrospektif çalışmada palyatif bakım servisinde primer ve metastatik beyin tümörü tanısı ile izlenen 91 hasta alındı. Çalışmaya alınan hastaların demografik özellikleri, glaskow koma skalası (GCS), Karnofsky Performans Skalası (KPS), çıkış durumu, hastanede yatış süresi ve semptomları karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 60,67 yıldı, %59,3’ü erkekti ve yatış süreleri ortalama 29,26 gündü. Primer beyin tümörü olan hastalarda PEG, trakeostomi durumu ve nöbet, parezi semptomu oranları anlamlı derecede fazla idi. (p<0,05) Metastatik tümörü olanlarda ve GCS düşük olanlarda çıkış durumu exitus olanlar anlamlı derecede fazla idi.(p=0,032, p=0,00) Sonuç: Primer ve metastatik beyin tümörü olan hastaların palyatif bakımda izlemleri sırasında bulgularında ve klinik prognozlarında farklılıklar olduğu gördük. Tedavilerdeki ilerlemelere rağmen zayıf prognoza sahip beyin tümörlerinin palyatif bakım ihtiyaçlarının belirlenip, semptomların iyi yönetilmesinin, bu hastalarda yaşam kalitesini artıracağını düşünüyoruz.

Keywords

• Beyin tümörleri
• palyatif bakım
• çıkış durumu
• nöbet

References

1. 1.Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68(1):7–30.
2. 2. Lyon JG, Mokarram N, Saxena T, Carroll SL, Bellamkonda RV. Engineering Challenges for Brain Tumor Immunotherapy. Adv Drug Deliv Rev. 2017;114:19–32.
3. 3. Wen PY, Kesari S. Malignant gliomas in adults. N. Engl. J. Med. 2008;359:492–507.
4. 4.Stupp R, Mason WP, Van Den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N. Engl. J. Med. 2005;352(10):987–996.
5. 5.Taillibert S, Delattre JY. Palliative care in patients with brain metastases. Curr Opin Oncol. 2005;17(6):588-592.
6. 6. Pease NJ, Edwards A, Moss LJ. Effectiveness of whole brain radiotherapy in the treatment of brain metastases: a systematic review. Palliat Med. 2005;19(4):288–99.
7. 7. Golla H, Nettekoven C, Bausewein C, et al. Effect of early palliative care for patients with glioblastoma (EPCOG): a randomised phase III clinical trial protocol. BMJ Open. 2020;10(1): e034378.
8. 8.Pace A, Dirven L, Koekkoek JAF, et al. European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma. Lancet Oncol. 2017;18(6):e330-e340.

9. 9.Noh T, Walbert T. Brain metastasis: clinical manifestations, symptom management, and palliative care. Handb Clin Neurol. 2018;149:75-88.
10. 10. Ayling OGS, Goldman R, Bernstein M. Glioblastoma, the Neurosurgeon, and Neuro-Palliative Care. Handb Clin Neurol. 2018;149:75-88.
11. 11.American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders , 19944th edition Washington, DC American Psychiatric Association.
12. 12.Mc Cormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18:1007–19.
13. 13.Aicher B, Peil H, Peil B, Diener H-C. Pain measurement: Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS) in clinical trials with OTC analgesics in headache. Cephalalgia. 2012;32(3):185–197.
14. 14, Teasdale G. Jennet B. Assesment of coma and impaired consicousness: A practical scale. Lancet 1974;2(7872):81-4.
15. 15. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer 1984;53(9):2002-7.
16. 16. Aras M, Delialioğlu ÜS, Atalay N, Selçuk ST. Kanser hastalarının rehabilitasyon gereksinimi. Türk Fiz Tıp Rehab Derg 2009;55(3):25-9.
17. 17. Hemminger LE, Pittman CA, Korones DN, et al. Palliative and end-of-life care in glioblastoma: defining and measuring opportunities to improve care. Neurooncol Pract. 2017;4(3): 182–88.
18. 18.Lucendo AJ, Friginal-Ruiz AB. Percutaneous endoscopic gastrostomy: An update on its indications, management, complications, and care. Rev Esp Enferm Dig. 2014;106(8):529-39.
19. 19.Schmidt E. [Percutaneous endoscopic gastrostomy-tube for a patient with glioblastoma to enable his admission into a nursing home]. Wien Med Wochenschr. 2010;160(13-14):328-30.
20. 20.Chan T, Devaiah AK. Tracheostomy in palliative care. Otolaryngol Clin North Am. 2009;42(1):133-41.
21. 21.Jakobsen TBT, Pittureri C, Seganti P, et al. Incidence and prevalence of pressure ulcers in cancer patients admitted to hospice: A multicentre prospective cohort study. Int Wound J. 2020;17(3):641-49.
22. 22.Alajbegović A, Loga N, Alajbegović S, Suljić E. Characteristics of symptomatic epilepsy in patients with brain tumours. Bosn J Basic Med Sci. 2009;9(1):81-4.
23. 23.Ostgathe C, Gaertner J, Kotterba M, et al. Differential palliative care issues in patients with primary and secondary brain tumours. Supportive care in cancer. 2010;18(9):1157-63.
24. 24. Pranckeviciene A, Bunevicius A. Depression screening in patients with brain tumors: a review. CNS oncology. 2015;4(2):71-8.
25. 25. Soffiettia R, Cornub P, Delattrec JY, et al. EFNS guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force, Eur. J. Neurol. 2006;13:674–81.
26. 26.Clark DE, Ryan LM. Concurrent Prediction of Hospital Mortality and Length of Stay from Risk Factors on Admission. Health Serv Res. 2002;37(3): 631–45.