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. 2023 Mar 14;25(3):447-456.
doi: 10.1093/neuonc/noac216.

Palliative care and end-of-life care in adults with malignant brain tumors

Johan A F Koekkoek  1   2 , Pim B van der Meer  1 , Andrea Pace  3 , Caroline Hertler  4 , Rebecca Harrison  5 , Heather E Leeper  6 , Deborah A Forst  7 , Rakesh Jalali  8 , Kathy Oliver  9 , Jennifer Philip  10 , Martin J B Taphoorn  1   2 , Linda Dirven  1   2 , Tobias Walbert  11
Affiliations

Palliative care and end-of-life care in adults with malignant brain tumors

Johan A F Koekkoek et al. Neuro Oncol. .

Erratum in

Abstract

Background: This systematic review provides updated insights, from the published literature in the past 5 years, based on the 2017 European Association of Neuro-Oncology (EANO) guidelines for palliative care in adults with malignant brain tumors. It provides an overview of palliative care options, including during the end-of-life phase for patients with malignant brain tumors.

Methods: A systematic literature search was conducted from 2016 to 2021 focusing on four main topics: (1) symptom management, (2) caregiver needs, (3) early palliative care, and (4) care in the end-of-life phase. An international panel of palliative care experts in neuro-oncology synthesized the literature and reported the most relevant updates. A total of 140 articles were included.

Results: New insights include that: Hippocampal avoidance and stereotactic radiosurgery results in a lower risk of neurocognitive decline in patients with brain metastases; levetiracetam is more efficacious in reducing seizures than valproic acid as first-line monotherapy antiseizure drug (ASD) in glioma patients; lacosamide and perampanel seem well-tolerated and efficacious add-on ASDs; and a comprehensive framework of palliative and supportive care for high-grade glioma patients and their caregivers was proposed. No pharmacological agents have been shown in randomized controlled trials to significantly improve fatigue or neurocognition.

Conclusions: Since the 2017 EANO palliative care guidelines, new insights have been reported regarding symptom management and end-of-life care, however, most recommendations remain unchanged. Early palliative care interventions are essential to define goals of care and minimize symptom burden in a timely fashion. Interventional studies that address pain, fatigue, and psychiatric symptoms as well as (the timing of) early palliative care are urgently needed.

Keywords: brain metastases; brain tumor; end of life; glioma; palliative care.

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Figures

Figure 1.
Figure 1.
Flow chart demonstrating results of the selection procedure.
See this image and copyright information in PMC

Comment in

References

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