Palliative Care in Neuro-oncology

This article reviews the palliative care needs of patients with primary and metastatic brain tumors and discusses the management of common symptoms associated with central nervous system tumors. It outlines the challenges and opportunities in providing palliative care for this population.

Patients with brain tumors generally have poor prognoses and have a high symptom burden. Neurologic symptoms affect not only physical function but also executive function and cognition. Most symptoms increase in the end-of-life phase and affect decision-making. Management of headaches, fatigue, seizures, and cognition can be challenging and is outlined in this article. Although the benefit of early palliative care for patients with systemic cancer is well established, how and when to integrate palliative care into the neuro-oncology pathway remains less understood. The use of palliative care and hospice in neuro-oncology remains underutilized.

Patients with brain tumors have high morbidity. The symptom profile of this patient population is distinct and differs from the needs of patients with systemic cancers. Neuro-oncologists are in a good position to improve and sustain health-related quality of life by providing primary palliative care for this patient population. Early conversations about prognosis and advance care planning may help increase the use of palliative care and hospice.