Palliative Care of Brain Metastases

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Palliative Care of Brain Metastases

Spiritual management

As with all cases of PC the complete assessment of the patient is important and the presence of supportive team, family, surrounding spiritual community, This may impact on the patients, pain, side/effect profile

Pharmacological management

Chemo and Radio therapy

Treatment of the primary tumour and whole brain radio therapy, stereotactic radiotherapy can be effective in g improving symptoms, may increase swelling, thus Steroids may be important

Neutropaenia

Due to Chemo and Radiotherapy, need for granulocyte-colony stimulating factor

Depression and Anxiety

In general in PC cases a high incidence of this, using Antidepressants like Citalopram may be helpful

Anaemia

Erythropoeitin seen as a help but need months, is expensive, but thought to have Brain specific effect at neurones have EPO receptors

Analgesia

Morphine is often necessary, may increase confusion be difficult to ascertain if drug or met the cause of LOC

Anti-coagulation

Patients immoblie, DVT Prophylaxis may be given, treating of Cerebral Vein Thrombosis, be careful with harmorragic conversion of mets, Warfarin INR testing must again wieh risk benefit

Anti-Epileptic Drugs

Only once seizures occur, prophylactic not beneficial, Sodium Valproate the drug of choice, newer agents may be helpful

Steroids

effective for cerebral oedema, N&V lowest dose to achieve best symptom control, many side effects but risk benefit

Subtopic

Non-Pharmacological management

Social Workers play important roles

PC in these cases results in less admissions, investigations, interventions and increased home deaths

Advanced Care Planning can assist in determining future extent of interventions

assessing treatment regimes and effect on Quality of Life is important

Side effect of the Chemo, steroids and Cancer are weakness and myopathy and fatigue EXERCISE MAY benefit, physiotherapy as well

Main topic

Assessment

99% of cases will be incurable and thus Palliative Care is Imperative

20-40% of all Cancers may develop BM, due to improved Cancer therapy overall and increased survival

Pre-BM higher function, psychological state and Karnofsky performance status

Diagnosis requires brain imaging CT Brain or MRI

Determines haemorrage, Cerebral Oedema, Raised Intracranial Pressure, Hydrocephalus, CVA or Mets, Venous Thrombosis

Presentation is usually with confusion, new onset seizures, focal neurology or headaches, nausea and vomiting