title: Identifying the palliative care needs of patients living with cerebral tumors and metastases: a retrospective analysis.
abstract: Primary tumors and metastatic involvement of the central nervous system (CNS) lead to a multitude of symptoms and care needs. Patients and caregivers struggle with physical and psychological impairments, a shortened life expectancy and diverse palliative care needs. This study assesses the symptom burden and palliative care needs of patients with primary brain tumors and with metastatic brain tumors requiring inpatient hospital care. It is a retrospective analysis of patients with primary CNS tumors or cerebral metastases over a 6 month period. The data analysed included physical symptom burden and end of life care decisions such as health care proxy, transition to hospice and do-not-resuscitate orders. Hundred and sixty eight patients were included. The most common symptoms were gait impairment (65.5 %), cognitive/personality change (61.9 %), motor deficits (58.3 %), seizures (57.1 %) and delirium (27.4 %). Of the patients that died, 79 % had an appointed health care proxy, 79 % had hospice discussions, 70 % had a do-not-resuscitate order and 24 % received cancer directed therapy in the last month of life. There is a role for more aggressive palliative care support in patients living with primary or metastatic brain tumors.
authors.affiliation: Division of Medicine, Department of Pain and Palliative Care, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. tgofton@uwo.ca
authors.forename: Teneille E
authors.initials: TE
authors.lastname: Gofton
authors.forename: Jerome
authors.initials: J
authors.lastname: Graber
authors.forename: Alan
authors.initials: A
authors.lastname: Carver
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy*; D002528:Cerebellar Neoplasms / Q000556:secondary* / Q000628:therapy*; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D060787:Neoplasm Grading; D010166:Palliative Care; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D019452:Terminally Ill