title: Dying of brain tumours: specific aspects of care.
abstract: OBJECTIVE
  Patients with brain tumours show a high symptom burden, and symptoms are difficult to treat and prone to be overlooked. This review of publications dealing with advanced stages of brain tumours tries to assess the knowledge gained in the past 2 years and to develop an outlook for further investigations.
  
  
  RESULTS
  We searched for publications on advanced brain tumours in a palliative medicine setting. Of 138 publications retrieved by search in PubMed, 22 publications met our criteria for inclusion. We predefined categories of interest: epidemiology and treatment of symptoms; quality of life; and impact on next of kin, caregivers, medico-social system and decision-making.
  
  
  CONCLUSIONS
  Data suggest that patients with primary or metastatic brain tumours often have a high symptom burden and unmet needs for palliative care, and symptoms are hard to diagnose; patients suffer often and early from cognitive impairment but are rarely appropriately prepared concerning end-of-life wishes. This reflects on their caregivers' burden as well. For symptomatic treatment of common symptoms such as fatigue, depression and cognitive impairment, methylphenidate has established an important role. For assessment of these symptoms, a shortened questionnaire Quality of Life Questionnaire-15-Palliative shows potential. Cancer-directed therapy in advanced stages of brain tumours has to be weighed critically. To assess adequate strategies to help patients and caregivers with the challenges of brain tumour-specific symptoms, randomized intervention studies are necessary. The same accounts for cancer-directed treatment in relation to quality of life in advanced stages of brain tumours.
authors.affiliation: aDepartment of Palliative Medicine, Comprehensive Cancer Centre CCC EMN bDepartment of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Steigleder
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stiel
authors.forename: Christoph
authors.initials: C
authors.lastname: Ostgathe
mesh_terms: D001932:Brain Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D002493:Central Nervous System Diseases / Q000209:etiology; D003072:Cognition Disorders / Q000209:etiology*; D003657:Decision Making; D003863:Depression / Q000209:etiology*; D005221:Fatigue / Q000209:etiology; D006801:Humans; D020380:Needs Assessment; D010166:Palliative Care / Q000379:methods / Q000523:psychology / Q000592:standards*; D011379:Prognosis; D039781:PubMed; D011788:Quality of Life; D013727:Terminal Care / Q000379:methods / Q000523:psychology / Q000592:standards*