Awareness of psychological and relationship problems amongst brain tumour patients and its association with carer distress.

OBJECTIVE: The aim of this research was to investigate if brain tumour patients underestimate the severity of their impairments and the impact of this behaviour on carer distress . This study also aimed to identify the support services that patients and carers experiencing distress would find most beneficial. METHOD: A total of 32 post-surgery brain tumour patients, their carers, and a control group of 29 patients following surgery to extra-cerebral areas and their carers were recruited from outpatient clinics. Patients and carers rated the patient's psychological well-being and the impact of a range of changes since diagnosis/surgery. Patients and carers also rated their own level of distress and the support services they would find most beneficial. RESULTS: When compared with the control group, brain tumour patients were more likely to underestimate their psychological problems (p < 0.005) and the negative impact of changes to their emotional function (p < 0.05), interpersonal relationships (p < 0.05), cognition (p < 0.05) and coping skills (p<0.05). A multiple regression analysis showed that underestimation of psychological and interpersonal problems by brain tumour patients explained 35% of the variance in their carer's anxiety. CONCLUSION: The finding of reduced awareness or denial in brain tumour patients and its contribution to increased carer anxiety highlights the need for therapeutic interventions, which improve patient insight/denial and encourage patient and carer communication.

A biobehavioral perspective on depressive symptoms in patients with cerebral astrocytoma.

More than 51,000 individuals are diagnosed with a primary brain tumor in the United States each year, and for those with the most common type of malignant tumor, an astrocytoma, almost 75% will die within 5 years of diagnosis. Although surgery, radiation, and chemotherapy have improved length of survival, mortality remains high, which underscores the need to understand how other factors affect the disease trajectory. Several recent studies have shown that depressive symptoms are independently associated with reduced quality of life and survival time after controlling for other variables in patients with an astrocytoma. Thus, depressive symptoms represent a significant risk factor for adverse outcomes in this patient population. A growing body of evidence indicates that depressive symptoms are linked to underlying biological phenomena, particularly inflammatory activation modulated through increased peripheral levels of proinflammatory cytokines. Recent research has shown that neoplastic astrocytes respond to elevated proinflammatory cytokine levels by secreting immune mediators within the central nervous system, including cytokines and glial fibrillary acidic protein that promote astrogliosis and angiogenesis and may increase tumor growth and metastasis. However, because these biological factors have not as yet been measured in conjunction with depressive symptoms in these patients, little is known about the interactions that potentially influence the treatment trajectory. To guide future research and to provide a deeper understanding of the factors that may influence depressive symptoms and length of survival in patients with an astrocytoma, a review of the literature was undertaken. Publications over the past 10 years were analyzed to examine the theoretical models and measures of depressive symptoms used in previous research. Although numerous studies have documented the relationship between depression and reduced length of survival, there were several methodological concerns identified, and there were no studies that included biological variables. Yet, research in the basic sciences provides compelling evidence of specific neuroendocrine-immune interactions orchestrated by astrocytes that can cause depressive symptoms and alter the tumor microenvironment so that standard treatments are not as effective. These findings support the need for clinically based research so that we can begin to understand the potentially modifiable biobehavioral mechanisms underlying depressive symptoms in patients with an astrocytoma. Grounded in the biobehavioral research paradigm of psychoneuroimmunology, a novel research program is presented that may provide a new level of understanding regarding the high prevalence of depressive symptoms in patients with an astrocytoma and lead to new treatment strategies, with possible implications for improved symptom management and quality of life in patients with brain tumors.

Validation of the National Institutes of Health Patient-Reported Outcomes Measurement Information System Survey as a Quality-of-Life Instrument for Patients with Malignant Brain Tumors and Their Caregivers.

At present there is a lack of well-validated surveys used to measure quality of life in patients with malignant brain tumors and their caregivers. The main objective of this pilot study was to validate the National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH PROMIS) survey for use as a quality-of-life measure in this population. This article presents the rationale for using the NIH PROMIS instrument as a quality-of-life measure for patients with malignant brain tumors and their caregivers.

Chemotherapy of astrocytomas: an overview.

OBJECTIVES: To provide an overview of the use of chemotherapy in the treatment of malignant brain tumors, with an emphasis on malignant gliomas. DATA SOURCES: Published articles, research studies, and reference books. CONCLUSIONS: Chemotherapy has primarily been used in a adjuvant setting after radiation therapy for primary brain tumors. This focus has not had a significant effect on survival. In an effort to more effectively treat the tumor, innovative chemotherapy treatments have been developed. These include the use of neoadjuvant chemotherapy, changes in timing of administration, new classes of chemotherapeutic agents, new routes of delivery, and augmentation of the body's own immune system to treat the tumor. IMPLICATIONS FOR NURSING PRACTICE: It is the challenge of the oncology nurse caring for the patient with a malignant brain tumor to gain knowledge of the disease process, side effect management, and the most up-to-date treatment regimens.

Neuro-oncology update: radiation safety and nursing care during interstitial brachytherapy.

Radiation control and safety are major considerations for nursing personnel during the care of patients receiving brachytherapy. Since the theory and practice of radiation applications are not part of the routine curriculum of nursing programs, the education of nurses and other health care professionals in radiation safety procedures is important. Regulatory agencies recommend that an annual safety course be given to all persons frequenting, using, or associated with patients containing radioactive materials. This article presents pertinent aspects of the principles and procedures of radiation safety, the role of personnel dose-monitoring devices, and the value of additional radiation control features, such as a lead cubicle, during interstitial brain implants. One institution's protocol and procedures for the care of high-intensity iridium-192 brain implants are discussed. Preoperative teaching guidelines and nursing interventions included in the protocol focus on radiation control principles.

ImuVert therapy in the treatment of recurrent malignant astrocytomas: nursing implications.

Malignant astrocytoma is a fatal, primary brain tumor affecting adults in the prime of life. Even with optimal treatment, median life expectancy from time of diagnosis is 51 weeks. Standard therapy consists of surgical debulking, radiation therapy and chemotherapy. Immunotherapy, utilizing biologic response modifiers (BRMs), affords one of the more promising treatment modalities. ImuVert, a BRM derived from Serratia marcescens, was recently granted orphan drug status by the Food and Drug Administration. In phase I and II clinical trials in patients with advanced malignant tumors, toxicities ranged from mild local reaction at injection sites to hypotension requiring vasopressors. ImuVert is currently being tested in a multicenter clinical trial as a treatment for recurrent malignant astrocytoma in adult patients. A comprehensive toxicity profile of brain tumor patients receiving ImuVert and techniques of managing adverse effects is presented.

Hyperthermia treatment for malignant brain tumors: nursing management during therapy.

Interstitial hyperthermia therapy, the application of heat to control or destroy tumor tissue, is under investigation as an adjuvant treatment for recurrent intracranial malignancies. A brief review of the biologic effects and detailed information of one technique used to treat brain tumors are presented. Management of patients receiving hyperthermia is both challenging and complex. Neuroscience nurses must become knowledgeable about this form of therapy as it is more widely used in brain tumor management.

Meningioma, astrocytoma and germinoma: case presentations of three intracranial tumors.

In this article three intracranial tumors are described including signs, symptoms and radiologic findings. Two of the more common tumor types are discussed--meningioma and astrocytoma, along with one less common type, the germinoma. The germinoma with its less common features provides an interesting comparison. Each tumor is exemplified using case presentations. The neuroscience nurse, in understanding the mechanisms by which these tumors manifest themselves, will be better able to predict treatment, outcome and correlate nursing care as necessary.

Current trends in the management of brainstem tumors in childhood.

Historically, the prognosis for a child diagnosed with a brainstem tumor has been bleak. The development of magnetic resonance imaging (MRI) has allowed for detailed visualization of tumors within the brainstem. This knowledge combined with the clinical history and neurological examination allows subcategorization of such tumors and delineation of children who might benefit from surgery. Surgical candidates include children with long clinical histories, focal neurological deficits and focal, cystic, exophytic or cervico-medullary tumors on the MRI scan. All children have the potential for multiple cranial nerve abnormalities, extremity weakness and swallowing and breathing difficulties. Nursing care of patients with brainstem tumors is complex and challenging.

Brain tumor resections guided by magnetic resonance imaging.

A major goal of surgical treatment of intracranial tumors is to achieve complete resection of the lesion while also preserving normal brain tissue and function. Conventional stereotactic systems used today to localize intracranial lesions are based on previously acquired imaging data sets. These data sets cannot provide surgeons with information about dynamic changes that occur during surgery. The recent development of intraoperative magnetic resonance imaging allows surgical resection to be performed through the eyes of the surgeon with concurrent magnetic resonance images. This advancement has revolutionized the way neurosurgical procedures are being performed.

Experiences with an intraoperative magnetic resonance imaging system in neurosurgery.

Magnetic resonance imaging (MRI) systems are becoming essential intraoperative tools in neurosurgery because they provide high-resolution, detailed images. Only a few institutions around the world currently have intraoperative MRI capabilities. Consequently, the body of knowledge with regard to safety procedures in such an environment is fragmented and often institution-specific. The components of the MRI system are described in relationship to surgical procedures. Perioperative nursing responsibilities are discussed and a case study is presented. The article concludes with a discussion about the present limitations of intraoperative MRI equipment.