Palliative care in patients with brain metastases

With improvements in systemic therapy, central nervous system metastases have increased in incidence in patients with cancer. Patients with brain metastases from solid tumors often have a dismal prognosis, and supportive measures are often critical in improving patient outcome. They include treatments against vasogenic edema, seizures, symptomatic venous thrombosis, and pain, and the management of iatrogenic side effects. This article reviews all the supportive care measures in patients with brain metastases, with the exception of tumor-specific chemotherapy treatments that are also used in this patient population.

Recently, improvement has been made in the management of the following complications of brain metastases: epilepsy and antiepileptic drug side effects, thromboembolic complications, fatigue and cognitive disorder of mixed (tumoral and/or iatrogenic) origin, pain, hematological side effects of chemotherapy, and steroids complications.

Patients with brain metastases are particularly prone to develop severe side effects, increased fatigue, and cognitive deteriorations following apparently minor changes in symptomatic treatments. Palliative management of brain metastasis requires a multidisciplinary approach, and it is important to avoid any treatment that is useless or harmful or has a poor toxicity/efficacy ratio.