Palliative care in patients with primary brain tumors

Purpose of review Because patients with primary brain tumors often present severe functional impairment as well as behavioral/cognitive dysfunction, they suffer from greater dependency and hopelessness than other cancer patients. Optimal management should not only focus on symptom relief through medication and physiotherapy, but should also take into account the psychosocial burden of the disease on the patients and their caregivers. This review updates available data on supportive care in patients with brain tumor. Recent findings Recent improvements have been made in the management of several complications of brain tumor: pain, epilepsy, and side effects of antiepileptic drugs; disability and related thromboembolic complications; cognitive disorders of mixed (tumoral and/or iatrogenic) origin; side effects of steroids; fatigue; and psychological consequences of the disease. Summary Avoiding useless "overtreatment" is the governing idea. A very thorough evaluation of the benefit/risk ratios is needed each time a new treatment is being considered. Brain tumor patients are particularly prone to develop severe side effects, increased fatigue, and cognitive deterioration following apparently minor changes in symptomatic treatments. Care is also needed to avoid useless prolongation of a burdensome situation. Another issue is that patients and their caregivers should benefit from the support of a multidisciplinary team to maintain realistic hopes and to anticipate critical decisions. Finally, guidelines from the literature are proposed to improve physicians' communication skills when treating these patients.