ABSTRACT
The common tumours within the nervous system, gliomas and cerebral metastases, are rarely curable. The most common primary brain tumour is glioblastoma multiforme. The terminal management of malignant tumours affecting the nervous system is challenging. The journey from acute presentation to death can be agonising. Evaluating the benefit–risk ratio in the management of neoplasms is critically important. The benefits of debulking surgery, radiotherapy and chemotherapy require balancing against the adverse effects of these relatively crude interventions. The propensity to develop sustained and troublesome anxiety, often precipitated by situations, is enhanced in those with brain tumours. The situation with depression is similar, the risk being enhanced by the multiple losses accumulated during the illness. Anxious irritability, rather than overt misery of mood, is not unusual in organic conditions. Both anxiety and depression are more likely early in the course of illness when insight and judgement is retained and the devastating impact on life is able to be acknowledged.
