Quality of Life and Role of Palliative and Supportive Care for Patients With Brain Metastases and Caregivers: A Review

Abstract

Brain metastases (BM) are the most commonly diagnosed secondary brain lesions in adults, influencing these patients' symptoms and treatment courses. With improvements in oncologic treatments, patients with BM are now living longer with their advanced cancers, and issues pertaining to quality of life become more pressing. The American Society of Clinical Oncology has recommended early implementation of palliative care for cancer patients, though incorporation and implementation of palliative and other supportive services in the setting of true multidisciplinary care requires additional attention and research for patients with intracranial metastases. We review the physical, cognitive, and psychosocial challenges patients with BM and their caregivers face during their cancer course as well as the current published research on quality of life metrics relating to this patient population and the diverse roles specialty palliative care, rehabilitation services, and other healthcare providers play in a comprehensive multidisciplinary care model.

The development of brain metastases in patients with different therapeutic strategies for metastatic renal cell cancer

“…The time lived with diagnosed BM is important to consider, as BM is usually diagnosed when symptomatic (>85% in our cohort), and these symptoms can significantly impact quality of life. 20 In addition, symptomatic BM often requires steroids, potentially affecting the efficacy of ICIs. Given these considerations, preventing or at least limiting the time with BM is warranted.…”

IMPACT the Brain: A Team-Based Approach to Management of Metastatic Breast Cancer With CNS Metastases

“… 46 , 47 There are fewer published quality-of-life investigations for patients with MBC and CNS metastases. 48 The PROs obtained in our program provide baseline data to bridge this knowledge gap, a necessary step to inform subsequent interventions. The baseline PROs suggest that patients struggle particularly with reduced physical function and increased fatigue compared with the general population.…”

Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis

“… 1 As neurocognition and quality of life are shifting to becoming primary treatment endpoints in these types of patients, the paramount importance of meaningful treatment and effective intracranial disease control is highlighted. 2 Treatment options consist of surgical removal, whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and targeted agents, and there should be individualization according to the patients’ Karnofsky Performance Status (KPS), the morphological structure of the malignant tumor, the feasibility of systemic therapy, as well as the number, size, and sites of metastatic lesions. 3…”