chapter  29
15 Pages

Supportive care

ByHerbert B. Newton, Mark G. Malkin

INTRODUCTION The modern treatment of neuro-oncology patients usually involves a team approach from a dedicated group of physicians, nurses, and support staff that specializes in various aspects of neuro-oncology, along with a tumor board specific for neuro-oncology patients (1). Although the focus of the treatment team will be on therapeutic strategies to control tumor growth (e.g., surgical resection, radiotherapy, and chemotherapy), many other facets of care are necessary and will involve patient support and symptom management, in an effort to maintain quality of life (QOL). The challenge for the treatment team begins at the moment of diagnosis, when the bad news (e.g., brain metastases and leptomeningeal involvement) must be communicated to the patient and family. Recent research suggests there are several important factors that should be considered when imparting a new cancer diagnosis (2). It is critical that the physician use simple, nontechnical language in a nonpatronizing manner, with a warm and caring tone. Every effort should be made to empathize with the emotions the patient is experiencing. The physician should sit close to the patient and maintain good eye contact. It is also permissible to initiate physical contact, in an effort to provide comfort. A quiet, private, and comfortable room should be used for the meeting, where interruptions and distractions can be minimized. Many patients also find it helpful when the physician gives some kind of warning that bad news is forthcoming and does not rush through the ensuing discussion. In addition, the physician must accurately gauge how explicit to be in terms of information regarding prognosis in the context of neuro-oncological disease. Some patients and families are medically sophisticated and well read, and realize that the prognosis for long-term survival is typically poor (3). In contrast, other patients and families are ambivalent or actively disinterested in learning about the poor prognosis associated with their disease (4). Each of these disparate situations will require a different approach by the physician, as the groundwork for active treatment is negotiated.