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Le Rhun É, Taillibert S, Blonski M, Jouniaux Delbez N, Delgadillo D, Taillia H, Auquier P, Belin C, Bonnetain F, Varin D, Tallet A, Taillandier L. [Supportive care, cognition and quality of life in brain metastases]. Cancer Radiother 2015; 19:55-60. [PMID: 25640218 DOI: 10.1016/j.canrad.2014.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper.
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Affiliation(s)
- É Le Rhun
- Neuro-oncologie, département de neurochirurgie, hôpital Roger-Salengro, CHRU, rue Émile-Laine, 59037 Lille cedex, France; Oncologie médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille cedex, France; Inserm U1192, laboratoire Prism, université Lille 1, bâtiment SN3 1(er) étage, 59655 Villeneuve d'Ascq cedex, France; Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France.
| | - S Taillibert
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Radiothérapie et neuro-oncologie, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Blonski
- Neuro-oncologie, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy, France
| | - N Jouniaux Delbez
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Delgadillo
- Neuro-oncologie, neurologie 2, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - H Taillia
- Neurologie, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France
| | - P Auquier
- Unité de recherche en santé publique, maladies chroniques et qualité de vie, faculté de médecine Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - C Belin
- Service de neurologie, CHU Avicenne AP-HP, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - F Bonnetain
- Méthodologie et qualité de vie en oncologie, EA 3181, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France; Plateforme qualité de vie et recherche clinique en oncologie, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - D Varin
- Soins palliatifs, groupe hospitalier Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Tallet
- Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France; Département d'oncologie-radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - L Taillandier
- Inserm U1192, laboratoire Prism, université Lille 1, bâtiment SN3 1(er) étage, 59655 Villeneuve d'Ascq cedex, France
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Sizoo EM, Pasman HRW, Dirven L, Marosi C, Grisold W, Stockhammer G, Egeter J, Grant R, Chang S, Heimans JJ, Deliens L, Reijneveld JC, Taphoorn MJB. The end-of-life phase of high-grade glioma patients: a systematic review. Support Care Cancer 2013; 22:847-57. [PMID: 24337718 DOI: 10.1007/s00520-013-2088-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/26/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-grade gliomas (HGG) are rare and incurable; yet, these neoplasms result in a disproportionate share of cancer morbidity and mortality. Treatment of HGG patients is directed not merely towards prolonging life but also towards quality of life, which becomes the major goal in the end of life (EOL). The latter has received increasing attention over the last decade. METHODS We reviewed the literature related to the EOL phase of HGG patients from 1966 up to April 2012. Articles were retrieved from PubMed, Embase, Cinahl, PsycINFO and Cochrane database. We then selected papers for analysis using pre-determined inclusion criteria and subtracted information on the topics of interest. RESULTS The search yielded 695 articles, of which 17 were classified eligible for analysis according to pre-defined inclusion criteria. Reviewed topics were symptoms and signs, quality of life and quality of dying, caregiver burden, organization and location of palliative care, supportive treatment, and EOL decision making. Nearly all identified studies were observational, with only two non-randomized intervention studies. Symptom burden is high in the EOL phase and affects the quality of life of both patient and carer. Palliative care services are more intensively used compared to other cancer patients. Cognitive deficits increase as the disease progresses, hampering communication and decision making. CONCLUSION The EOL phase of HGG is substantially different from other patient groups, and more clinical studies in HGG on supportive medication, advance care planning and decision making are required. The organization of care, development of guidelines and interventions to decrease caregiver burden in the EOL phase are critical as well.
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Affiliation(s)
- Eefje M Sizoo
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands,
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Abstract
Brain metastases affect 37% of patients suffering from metastatic melanoma, and their prognosis remains poor, with an overall survival lower than six months. At the moment, there is no standard therapeutic strategy for management of melanoma brain metastases. In some cases, having recourse to a systemic treatment is justified, for example, when brain metastases are combined with a progressive peripheral disease, or with unresecable brain lesions. In France, the use of fotemustine, which received the AMM approval, for metastatic melanoma treatment, is one of the treatments recommended in the case of brain metastases as this chemotherapy, that is active on the melanoma passes the blood-brain barrier. Temozolomide also shows some activity in the brain metastases treatment of melanoma that remains modest in monotherapy but seems interesting when it is combined with radiotherapy. The place of new drugs, in particular ipilimumab and vemurafenib, in the strategy of melanoma brain metastases treatment, still has to be defined and may improve the prognosis of these patients and their quality of life. The new targeted therapies, the widespread use of stereotactic radiosurgery and the improvement in neurosurgical operations would need a prospective clinical assessment, all the more so, in most of clinical studies, the presence of metastases is an exclusion criterion.
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