Supportive care for patients with brain cancer and their families
Supportive care for patients with brain cancer and their
Highlights from the 9th Meeting of the European Association of Neuro-
September 16-19, 2010, Maastricht, The Netherlands
A diagnosis of brain cancer is very distressing to the individual and to his/her
partner and relatives. In the course of the disease, many patients suffer from
depression, and the disease also has a social impact on family life. A growing
awareness of the need to tackle these problems in the clinical setting has led to
various suggestions as to how neuro-oncology specialist nurses and physicians
could offer support and psychosocial assistance to patients and their families.
Diagnosing and tackling depression in patients with brain cancer
Depression is a common occurrence in patients with brain cancer, and it involves
emotional, cognitive, and physical sequelae. Depression appears to be associated
with increased morbidity and mortality in this patient population and importantly,
it is the most important independent predictor of quality of life (QoL) for patients
with brain cancer.
The root cause of the depression may be linked to the location of the tumour, the
forms of treatment, and the patient’s response to the diagnosis. In general,
depression in these patients is under-diagnosed; the psychiatric symptoms can
often be unrecognized or mistaken for neurological symptoms of the brain tumour.
A common theme of the presentations on this topic at the EANO meeting is that
patients should be evaluated for depression before, during, and after treatment of
their brain cancer. Early treatment of depression might decrease the morbidity and
mortality and improve the QoL of these patients.
Identifying clinical depression in patients with brain tumours
Dr. Alasdair Rooney (Edinburgh Centre for Neuro-oncology, Western General
Hospital, Edinburgh, UK) outlined the results of a prospective, twin-centre,
longitudinal cohort study to assess the frequency, course and clinical associations
of major depressive disorder (MDD) in adults with glioma (O.49).
MDD was diagnosed in almost 20% of the patients during the study period and it
was still present at the reassessment after 3 months. Functional impairment and
emotional distress were identified as independent risk factors. Dr. Rooney
suggested that clinicians should screen for depression in patients with glioma who
report high distress on the NCCN distress thermometer or who are functionally
impaired (KPS ≤70).
Although there is greater recognition of the importance of early detection of the
symptoms of depression, a validated tool for screening for depression in adults
with glioma is lacking. In a separate presentation (O.51), Dr. Rooney suggested
that the depression subscale of the hospital anxiety and depression scale (HAD-D)
could be used to improve the standard of supportive and psychological care for
adults with glioma. He cautioned however that the impact of cognitive impairment
and the reproducibility and internal consistency of the scale remain to be studied.
The supportive role of the specialist nurse
The neuro-oncology specialist nurse (NOSN) plays a key role in acting as a point
of contact for patients, their caregivers, and all the healthcare professionals
involved in the clinical management of the patient with a brain tumour.
Dr. Madelena Stauss (James Cook University Hospital, Middlesbrough, UK)
reported on an assessment of the involvement of NOSNs in the management of
patients with a diagnosis of high-grade malignant glioma.
This study involved a retrospective review of NOSN records relating to the
management of 123 patients (70 males and 43 females; mean age, 59 years) who
were diagnosed with intracranial glioma of WHO grades III and IV from July 2007
to June 2009. NOSN involvement with the patients was low at the time of initial
consultation but there was increased involvement in 93% of the cases during
treatment. The NOSN was also in contact with caregivers and dealt with clinic
scheduling, symptom management, medication/steroids, psychological support,
and referral to other agencies. The NOSN also had significant contacts with other
health professionals as part of the process of advancing patient care.
This study underlines the key role of the NOSN, who has a very high workload, in
the management of patients with malignant glioma.
Psychosocial counselling for patients with glioblastoma
Patients with glioblastoma are confronted with serious psychosocial issues. A
study to evaluate the need for psycho-social counselling as part of the treatment
plan for patients with glioblastoma was described by Dr. M. Krutzen (MAASTRO
Clinic, Maastricht University Medical Center, Maastricht, The Netherlands).
In this study, patients who were treated for a primary glioblastoma were referred
for standard counselling at the beginning of their radiotherapy. Of the 101 referred
patients, 43 (42.6%) were actively followed up, whereas 58 (57%) patients did not
require further psychosocial support. Problem areas that were identified during
counselling included euthanasia, work-related problems, housing, children,
changes in behaviour, partner issues, and problems with coping.
If psychosocial counselling is integrated into the treatment plan for patients with
glioblastoma, the hurdle of seeking advice would be lowered and support would be
more easily accepted, and consequently, more patients would make use of follow-
up counselling. Dr. Krutzen proposed that “standard counselling should be
integrated into the overall treatment plan to improve the quality of life for patients
and their families”.