Mental incapacity in patients undergoing neuro-oncologic treatment

Kerrigan, Simon; Erridge, Sara; Liaquat, Imran; Graham, Cat; Grant, Robin

doi:10.1212/wnl.0000000000000671

Cited by 47 publications

(52 citation statements)

References 10 publications

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“…The use of simple cognitive screening tests, such as semantic verbal fluency, may help. This requires assessment of how many animals the patient can name in one minute and has been previously demonstrated to be worse in brain tumour patients whose initial presenting symptom was headache/headache ‘plus’ ( 28 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Symptoms in primary care with time to diagnosis of brain tumours

et al. 2018

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BackgroundBrain tumours often present with varied, non-specific features with other diagnoses usually being more likely.ObjectiveTo examine how different symptoms and patient demographics predict variations in time to brain tumour diagnosis.MethodsWe conducted a secondary analysis of brain tumour cases from National Audit of Cancer Diagnosis in Primary Care. We grouped neurological symptoms into six domains (headache, behavioural/cognitive change, focal neurology, ‘fits, faints or falls’, non-specific neurological, and other/non-specific) and calculated times for patient presentation, GP referral, specialist consultation and total pathway interval. We calculated odds ratios (ORs) for symptom domains comparing the slowest to other quartiles.ResultsData were available for 226 cases. Median (interquartile range) time for the total pathway interval was 24 days (7–65 days). The most common presentation was focal neurology (33.2%) followed by ‘fits, faints or falls’ and headache (both 20.8%). Headache only (OR = 4.11, 95% CI = 1.10, 15.5) and memory complaints (OR = 4.82, 95% CI = 1.15, 20.1) were associated with slower total pathway compared to ‘fits, faints or falls’. GPs were more likely to consider that there had been avoidable delays in referring patients with headache only (OR = 4.17, 95% CI = 1.14, 15.3).ConclusionPatients presenting to primary care with headache only or with memory complaints remain problematic with potentially avoidable delays in referral leading to a longer patient pathway. This may or may not impact on the efficacy and morbidity of therapies. Additional aids are required to help doctors differentiate when to refer headaches and memory complaints urgently for a specialist opinion.

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Section: Discussionmentioning

confidence: 99%

Symptoms in primary care with time to diagnosis of brain tumours

et al. 2018

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“…Indeed, Kerrigan et al found that the majority (64%) of glioblastoma patients were mentally incapacitated prior to surgery [39], hampering decision-making. This underlines that early implementation of ACP discussions is warranted in this unique patient population.…”

Section: Relevance Of Acp In Glioblastoma Patientsmentioning

confidence: 99%

Advance Care Planning in Glioblastoma Patients

Fritz

Dirven

Reijneveld

et al. 2016

Cancers

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Despite multimodal treatment with surgery, radiotherapy and chemotherapy, glioblastoma is an incurable disease with a poor prognosis. During the disease course, glioblastoma patients may experience progressive neurological deficits, symptoms of increased intracranial pressure such as drowsiness and headache, incontinence, seizures and progressive cognitive dysfunction. These patients not only have cancer, but also a progressive brain disease. This may seriously interfere with their ability to make their own decisions regarding treatment. It is therefore warranted to involve glioblastoma patients early in the disease trajectory in treatment decision-making on their future care, including the end of life (EOL) care, which can be achieved with Advance Care Planning (ACP). Although ACP, by definition, aims at timely involvement of patients and proxies in decision-making on future care, the optimal moment to initiate ACP discussions in the disease trajectory of glioblastoma patients remains controversial. Moreover, the disease-specific content of these ACP discussions needs to be established. In this article, we will first describe the history of patient participation in treatment decision-making, including the shift towards ACP. Secondly, we will describe the possible role of ACP for glioblastoma patients, with the specific aim of treatment of disease-specific symptoms such as somnolence and dysphagia, epileptic seizures, headache, and personality changes, agitation and delirium in the EOL phase, and the importance of timing of ACP discussions in this patient population.

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“…Over the last few decades, patients and their family members are increasingly being involved in care decisions (Colligan, Metzler, & Tiryaki, 2017;Kane, Halpern, Squiers, Treiman, & McCormack, 2014). To be able to make informed decisions, patients need sufficient cognitive abilities and self-awareness, but these functions can be disturbed in patients with brain disorders (e.g., Day et al, 2016;Kerrigan, Erridge, executive functions are necessary for, among others, assessing probabilities, categorizing options, selecting decision-making strategies, and using feedback to revise strategies if necessary (Schiebener et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Executive Functioning in Patients with Meningioma and Low-Grade Glioma: A Comparison of Self-Report, Proxy-Report, and Test Performance

Linden

Gehring

Baene

et al. 2019

J Int Neuropsychol Soc

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Objective:This study aimed to examine: (1) patient–proxy agreement on executive functioning (EF) of patients with primary brain tumors, (2) the relationships between patient- and proxy-report with performance-based measures of EF, and (3) the potential influence of performance-based measures on the level of agreement.Methods:Meningioma and low-grade glioma patients and their informal caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF-A) 3 months after surgery. The two index scores of the BRIEF-A, Behavioral Regulation and Metacognition, were evaluated. Mean scores of patients and proxies were compared with normative values and with each other. Patient–proxy agreement was evaluated with Lin’s concordance correlation coefficients (CCCs) and Bland–Altman plots. Pearson correlation coefficients between reported EF and performance-based measures of EF were calculated. Multiple regression analysis was used to evaluate the potential influence of test performance on differences in dyadic reports.Results:A total of 47 dyads were included. Patients reported significantly more problems on the Metacognition Index compared to norms, and also in comparison with their proxies. Effect sizes indicated small differences. Moderate to substantial agreement was observed between patients and proxies, with CCCs of 0.57 and 0.61 for Metacognition and Behavioral Regulation, respectively. Correlations between reported EF and test performance ranged between −0.37 and 0.10. Dyadic agreement was not significantly influenced by test performance.Conclusions:Patient–proxy agreement was found to be moderate. No clear associations were found between reported EF and test performance. Future studies should further explore the existing and new methods to assess everyday EF in brain tumor patients.

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Mental incapacity in patients undergoing neuro-oncologic treatment

Cited by 47 publications

References 10 publications

Symptoms in primary care with time to diagnosis of brain tumours

Symptoms in primary care with time to diagnosis of brain tumours

Advance Care Planning in Glioblastoma Patients

Assessment of Executive Functioning in Patients with Meningioma and Low-Grade Glioma: A Comparison of Self-Report, Proxy-Report, and Test Performance

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