Chapter 32 - End of life care for patients with meningioma

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Abstract

Palliative care (PC) supports patient with serious illnesses and can help patients with meningioma through the phases of their clinical trajectory, from initial diagnosis through the last hours of life. The PC team implements a multimodal transdisciplinary approach to address physical, psychosocial, and spiritual suffering with patients and their families, while also fostering constructive communication with the many health care providers involved. To achieve these goals the PC core team is comprised of physicians, nurse practitioners, physician assistants, nurses, social workers, and spiritual care providers who are trained to take care of patients with serious illnesses and to provide support to their families. The PC intervention can be instituted concurrently with all other treatments including those with a curative intent, and symptom management can be implemented while at the same time addressing reversible causes of distress. PC is practiced in acute care centers and long-term care facilities, usually by a consulting team, but other settings include outpatient clinics and home. When patients experience recurrence of their tumor and their life expectancy is shortened to 6 months or less, a hospice can provide the same transdisciplinary support by focusing on quality of life and symptom management for the patient while assisting the family through the clinical course and providing professional bereavement services after the patient's death.

Introduction

Patients with meningioma face clinical and existential challenges that become increasingly intense when the tumor recurs after standard treatment and when it reaches a stage that cannot be altered by even the most aggressive treatment. Rarely, a severe complication of initial surgery may cause serious neurologic deficits that the patient cannot recover from. These challenges require an interdisciplinary intervention that addresses all aspects of the patient's and family's experience throughout the disease trajectory. Palliative care (PC) plays an important role in this context, particularly when involved early in the process.

Section snippets

Definition of PC

According to the World Health Organization (WHO) “Palliative Care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (World Health Organization, 2019).

Put another way, PC “… aims to relieve suffering and improve the

PC and Disease Trajectory

The early involvement of the PC team helps to address the entire experience of suffering with timely intervention on symptoms and psychosocial and spiritual distress. After diagnosis and treatment, patients with recurrent meningioma face several clinical scenarios that may follow one another: cure and return to normal life; cure with persistent symptoms from side effects of therapy (i.e., neuropathy, chronic pain); recurrence of the tumor that may not be sensitive to chemotherapeutic agents

Advance Care Planning

The written and verbal communication to providers and surrogate decision makers regarding values and preferences for care is essential with all diagnoses of serious illness. This dialog, referred to as advance care planning (ACP), becomes more imperative with a brain tumor diagnosis, as neurologic deficits may impact mental capacity and decision-making ability later in the course of illness. Through ACP, a patient provides guidance to surrogate decision makers regarding their preferences for

Conclusion

PC can help patients with recurrent meningioma throughout the phases of their clinical trajectory, from initial diagnosis of recurrent, untreatable disease through the last hours of life. The PC team addresses the physical, psychosocial, and spiritual domains of suffering in different settings with a multimodal transdisciplinary intervention, which is most effective when implemented early in the course of the illness. Patients with meningioma will greatly benefit from the growing role that PC

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