Abstract
Initial medical management of glioma will depend on distinguishing symptoms related to the direct effects of the tumour, from those that are secondary to the stress or recurrence of a pre-existing psychological illness, and symptoms that are related to medication. The cause of symptoms may vary with time, e.g. headache from raised intracranial pressure to post-craniotomy headache or migraine; therefore the history should be revisited regularly to ensure the most effective treatment is prescribed. Prevention of perioperative complications, e.g. deep vein thrombosis and pulmonary embolus or post-operative seizures, may complicate the management. Care must be taken to minimise medication that may interact with future treatment or produce neurological side effects.
During oncological therapies medical management may involve reducing unnecessary treatment and consolidating support and advice, e.g. on management of epilepsy, treatment of mood disorders and diagnosis and management of ongoing or new symptoms such as headache, seizures, spasticity, bladder problems and fatigue. Neuro-rehabilitation and neurocognitive rehabilitation should be established as early as possible after initial surgery.
Late effects of treatment become an issue in long-term survivors depending on the radiation therapy dose and volume. Late effects may produce episodic disturbances related to vascular, epileptic or metabolic disturbances or a progressive neurocognitive and physical decline that usually requires more complex packages of supportive and palliative care. Endocrine effects from radiation on the pituitary gland are reversible. In late stages of illness, good symptom management is the difference between a peaceful death and a stressful memory that will live with the family forever.
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Kerrigan S, Erridge SE, Liaquat I, et al. Mental incapacity in patients undergoing neuro-oncologic treatment: a cross-sectional study. Neurology. 2014;83(6):537–41.
Grant R. Overview: brain tumour diagnosis and management/Royal College of Physician Guidelines. J Neurol Neurosurg Psychiatry. 2004;75(Suppl 2):18–23.
Vecht CJ, Hovestadt A, Verbiest HB, van Vliet JJ, van Putten WL. Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day. Neurology. 1994;44:675–80.
Weston J, Greenhalgh J, Marson AG. Antiepileptic drugs as prophylaxis for post-craniotomy seizures. Cochrane Database Syst Rev. 2015;(3):CD007286.
Tremont-Lukats IW, Armstrong T, Gilbert MR. Antiepileptic drugs for preventing seizures in people with brain tumors. Cochrane Database Syst Rev. 2008;(2):CD004424.
Walker M. Status epilepticus: an evidence based guide. BMJ. 2005;331(7518):673–7.
Simanek R, Vormittag R, Hassler M, et al. Venous thromboembolism and survival in patients with high-grade glioma. Neuro Oncol. 2007;9:89–95.
Dickinson LD, Miller LD, Patel CP, Gupta SK. Enoxaparin increases the incidence of post-operative intracranial haemorrhage when initiated pre-operatively for deep vein thrombosis in patients with brain tumours. Neurosurgery. 1998;43:1074–81.
Perry JR, Julian JA, Laperriere NJ, et al. PRODIGE: a randomised placebo controlled trial of dalteparin low molecular weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma. J Thromb Haemost. 2010;8(9):1959–65.
De Benedittis G, Lorenzetti A, Migliore M, Spagnoli D, Tiberio F, Villani RM. Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery. 1996;38(3):466–9.
Kaur A, Selwa L, Fromes G, Ross DA. Persistent headache after supratentorial craniotomy. Neurosurgery. 2000;47:633–6.
Piil K, Juhler M, Jakobsen J, Jarden M. Controlled rehabilitative and supportive care intervention trials in patients with high-grade gliomas and their caregivers: a systematic review. BMJ Support Palliat Care. 2016;6(1):27–34.
Bartolo M, Zucchella C, Pace A, et al. Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours. J Neurooncol. 2012;107(3):537–44.
Khan F, Amatya B, Ng L, Drummond K, Galea M. Multidisciplinary rehabilitation after primary brain tumour treatment. Cochrane Database Syst Rev. 2015;(8):CD009509.
Day J, Gillespie DC, Rooney AG, et al. Neurocognitive deficits and neurocognitive rehabilitation in adult brain tumors. Curr Treat Options Neurol. 2016;18(5):22–32.
Gehring K, Sitskoorn MM, Gundy CM, et al. Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol. 2009;27(22):3712–22.
Gehring K, Patwardhan SY, Collins R, et al. A randomized trial on the efficacy of methylphenidate and modafinil for improving cognitive functioning and symptoms in patients with a primary brain tumor. J Neurooncol. 2012;107(1):165–74.
Meyers CA, Weitzner MA, Valentine AD, Levin VA. Methylphenidate therapy improves cognition, mood, and function of brain tumor patients. J Clin Oncol. 1998;16(7):2522–7.
Shaw EG, Rosdhal R, D’Agostino RB Jr, et al. Phase II study of donepezil in irradiated brain tumor patients: effect on cognitive function, mood, and quality of life. J Clin Oncol. 2006;24(9):1415–20.
Rooney AG, Brown PD, Reijneveld JC, et al. Depression in glioma: a primer for clinicians and researchers. J Neurol Neurosurg Psychiatry. 2014;85:230–5.
Chambers SK, Grassi L, Hyde MK, Holland J, Dunn J. Integrating psychosocial care into neuro-oncology: challenges and strategies. Front Oncol. 2015;5:4.
DeRubeis RJ, Siegle GJ, Hollon SD. Cognitive therapy vs. medications for depression: treatment outcomes and neural mechanisms. Nat Rev Neurosci. 2008;9(10):788–96.
Burke W. The neural basis of Charles Bonnet hallucinations: a hypothesis. J Neurol Neurosurg Psychiatry. 2002;73:535–41.
Armstrong TS, Cron SG, Bolanos EV, et al. Risk factors for fatigue severity in primary brain tumor patients. Cancer. 2010;116(11):2707–15.
Day J, Yust-Katz S, Cachia D, Wefel J, Katz LH, Tremont I, Bulbeck H, Armstrong T, Rooney AG. Interventions for the management of fatigue in adults with a primary brain tumour. Cochrane Database Syst Rev. 2016;(4):CD011376. https://doi.org/10.1002/14651858.CD011376.pub2.
Boele FW, Douw L, de Groot M, et al. The effect of modafinil on fatigue, cognitive functioning, and mood in primary brain tumor patients: a multicenter randomized controlled trial. Neuro Oncol. 2013;15(10):1420–8.
Page BR, Shaw EG, Lu L, et al. Phase II double-blind placebo-controlled randomized study of armodafinil for brain radiation-induced fatigue. Neuro Oncol. 2015;17(10):1393–401.
Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, van Dijk JG, Fitzpatrick A, Hohnloser S, Janousek J, et al. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J. 2001;22(15):1256–306.
Farid K, Meissner WG, Samier-Foubert A, et al. Normal cerebrovascular reactivity in stroke-like migraine attacks after radiation therapy syndrome. Clin Nucl Med. 2010;35(8):583–5.
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Grant, R. (2019). Medical Management of Adult Glioma. In: Oberg, I. (eds) Management of Adult Glioma in Nursing Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-76747-5_5
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