Characteristics of patients with brain metastases from lung cancer in a palliative care center

Abstract

Purpose and methods: Patients with brain metastases present severe symptoms owing to the tumor growth or treatment side effects, and supportive measures are often critical for the patients and their families. However, there is currently a lack of palliative care and end-of-life (EoL) provision for patients affected by advanced brain tumors. We performed a retrospective analysis of the characteristics of patients with brain metastases from lung cancer between August 1998 and December 2008 in our palliative care center.

Results: During this period, 55 such patients died. The male/female ratio was 0.86, and the mean age was 60.7 years. The duration of the last stay before death varied between 2 and 196 days (mean, 42.6 days). Death appeared predictable as the consequence of end-stage disease in all cases. The most frequent general clinical complaints were pain (64.8%), general fatigue (46.2%), and dyspnea (31.4%). The most frequent symptoms related to the brain tumors were consciousness deterioration (33%), headache (26%), cranial nerve palsy (19%), and delirium (19%). The symptoms in patients with carcinomatous meningitis were headache (63.6%), cranial nerve palsy (45.4%), epilepsy (27.2%), and nausea and vomiting (27.2%). The therapy tools used were chemotherapy in 9% and steroids and glycerol in 32.7%. Four patients who had leptomeningeal carcinomatosis suffered from hydrocephalus, and treatments for vasogenic edema or antalgics were less effective. In such cases, cerebrospinal fluid drainage may be effective if there are no space-occupying lesions. One patient had cortical atrophy with cognitive impairment and another had a cerebral infarction during admission.

Conclusion: Optimization of the quality of life in its final stages requires efficient palliative care, which involves considerable psychological, sociological, technical, and financial burdens. Palliative management of brain metastases requires a multidisciplinary approach performed by a well-trained neuro-oncology team, and it is important to avoid any treatment that is harmful or has a poor toxicity/efficacy ratio to avoid inappropriate prolongation of dying.