Odyssey of hope: a physician's guide to communicating with brain tumor patients across the continuum of care.

The optimal treatment of a patient with a malignant brain tumor requires attention to the physical and emotional well-being of the affected individual and the family. We review the concept of hope as a critical support modality throughout the continuum of care for brain tumor patients and families. We offer suggestions based on our own observations over 17 years as well as the lessons taught to us by our patients and their families over that time and through a structured interview process.

Neurology resident learning in an end-of-life/palliative care course.

OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) requires neurology residents receive instruction in End-of-Life Care/Palliative Care (EOLPC), but survey data from 24 neurology programs in the National Residency End-of-Life Physician Education Project (NRELEP) demonstrated faculty and residents tend to rate themselves as able to perform EOLPC despite significant knowledge gaps. We participated in the NRELEP to develop an EOLPC course and assess resident learning following this new curriculum. METHODS: Fifteen residents and 8 nonparticipant faculty completed a content validated knowledge pretest and precourse EOLPC confidence self-assessment tool. The course plan developed during a NRELEP conference consisted of 14 weekly 1-hour sessions covering a variety of topics pertinent to EOLPC care in neurology. Sessions included lectures, role-play, and group problem-solving formats. Residents attended sessions while faculty did not. The postcourse assessment included a posttest and the EOLPC self-assessment, and was completed by 14 residents and 5 comparison faculty. RESULTS: The mean pretest score was 48.1% +/- 16.9% for residents and 59.0% +/-8.2% for faculty. Posttest scores improved to 67.2% +/- 10.6% for residents (t test, p +/- 0.001), but not for the faculty group (52.4% +/- 9.9%, p = 0.2). Resident EOLPC confidence self-assessment significantly improved after the course (precourse mean, 3.09 +/- 1.01; postcourse mean, 3.40 +/- 0.93, p < 0.001), while there was no change in faculty confidence (precourse mean, 3.48 +/- 0.82; postcourse mean, 3.41 +/- 0.82, p = 0.5). Residents performed significantly better than faculty on the posttest (p = 0.01). CONCLUSIONS: An EOLPC course was developed and implemented in this program. Residents exhibited demonstrable learning and improved self-assessment of confidence in providing EOLPC following introduction of the course.

The challenges of long-term treatment outcomes in adults with malignant gliomas.

Malignant gliomas are among the most devastating tumors, with survival only one to three years after diagnosis even with the best of treatments. For this reason, long-term follow-up has not been established. Patients who do survive have significant disabilities, which compromise patient and family quality of life (QOL). Side effects from a brain tumor are dependent on the location of the tumor in the brain and can cause significant cognitive, emotional, and social effects on patients and families. Surgical treatment options also are dependent on the location of the tumor in the brain, and some sites remain inoperable (e.g., brain stem, motor strip). Radiation therapy continues to remain the mainstay of treatment for this patient population. The advent of newer technologies in radiation and chemotherapy and the development of novel treatments have increased survival. As survival increases, QOL issues become more important to patients and families. Impairment, disability, and handicap are measurements of QOL used by healthcare professionals. A multitude of studies has produced evidence regarding the impact of tumor location and size on QOL, whereas other studies have demonstrated the effects that various treatment modalities have on QOL. Few studies actually have provided insight into the everyday consequences that tumors pose on patients. Understanding the significance and causes of these impairments, disabilities, and handicaps will assist oncology nurses in caring for this special population.

Durable response of breast cancer leptomeningeal metastasis to capecitabine monotherapy.

We report a durable (12-month) response to capecitabine monotherapy, shown clinically, by MRI, and by cerebrospinal fluid analysis, in a patient with leptomeningeal metastasis from breast cancer.