Neuro-oncology and supportive care: the role of the neurologist

The diagnosis of a brain tumor is a life-changing event for patients and their families. Despite numerous treatment advances, malignant brain tumors are universally incurable and long-term survival is limited. Treatment response, prognosis, and survival depend on underlying histopathology and recently defined molecular features. Patients suffer from a disproportionately high symptom burden throughout the disease trajectory and at the end of life. Pronounced neurologic decline and psychological distress significantly impair quality of life (QoL) and impose high supportive care needs relative to other systemic cancers. Palliative interventions addressing brain tumor-specific symptoms, such as seizures, cognitive dysfunction, and headaches, are paramount to maintaining QoL. In the terminal phase of illness, most brain tumor patients lose the ability to communicate and participate in end-of-life decision-making. The benefits of advance care planning and early integration of specialized palliative care are well-established in other systemic cancers and have received wider recognition in neuro-oncology. We review how to approach neurological symptoms in brain tumor patients, as well as address prognosis and advance care planning with the goal of improving QoL for patients and caregivers.