Glioblastoma is the most common incurable primary brain malignancy in adults.
Median age at diagnosis is 64.
Median survival from diagnosis is 15 months. Extended survival is possible with favorable genetic mutations, age < 50 years, and a fully independent postoperative functional status. Two-year survival after diagnosis is 27%; 5-year survival is 10%.
Its illness trajectory is associated with a rapid rate of cognitive deterioration preceding the functional decline of the dying phase of cancer.
Tumor size and location, and cancer treatment side effects are the most common determinants of how symptoms manifest.
- Focal deficits. Hemiparesis, aphasia, paresthesias, dysarthria, dysphagia, visual changes.
- Cognitive changes. Depression, anxiety, memory loss, personality changes, agitation, delirium.
- Headache, nausea, and fatigue.
For newly diagnosed patients with a preserved performance status, standard treatment involves maximal safe surgical resection followed by concomitant chemotherapy and radiotherapy.
Essentially all patients will experience disease recurrence for which no standard treatment exists and any combination of repeat surgical resection, re-irradiation, and chemotherapy are possible.
Palliative care is an appropriate option for patients with recurrent glioblastoma, particularly those with comfort-based goals of care and/or a poor performance status.
Adapted from Patel RA, Neil E, Maiser S. Palliative care issues in glioblastoma. Palliative Care Network of Wisconsin. Fast facts and concepts #350. Internet. Accessed on April 30, 2018.