Critical Care in Neuro-Oncology: Balancing Aggressive Treatment with Quality of Life

Caring for patients with brain tumours is one of the most difficult—and very humane—facets of Oncology.  Brain tumours damage the organ that governs how we move, think, communicate, and even feel.  A neuro-oncology diagnosis causes substantial emotional and cognitive upheavals for patients and their families, in addition to physical impairments.  As medical practitioners’, the treatment should go beyond managing the disease, to encompass stewardship of the patients’ quality of life.

Understanding Complexity

Brain tumours is not just about an illness.  They include benign meningiomas that grow slowly, and aggressive glioblastomas.  Few are metastatic, and originate elsewhere in the body, while others are primary brain malignancies.  Surgery, radiation, chemotherapy, targeted medicines, and, increasing immunotherapy, are the best possible treatment choices.

The location of this tumour frequently affects neurological function, which complicates therapy considerations in neuro-oncology.  A tiny lesion in the brainstem may be more damaging than a larger one in non-eloquent location.  Similarly, vigorous treatment that shrinks the tumour may result in speech loss or paralysis.

This is why essential care in neuro-oncology should be highly customized.  This necessitates not just technical expertise, but sensitivity and thoughtful communication.

“Say No to Aggression”

The term “aggressive treatment” frequently, and sometimes, misleadingly, conveys a sense of hope.  Here, we must take a pause and re-consider our goals.

In rare circumstances, maximal treatment can purchase time, while maintaining function.  In other cases, it may exacerbate misery, without providing real benefit.  For example, a patient with recurrent high-grade glioma, who had undergone numerous surgeries and chemotherapy rounds, may have significant declining returns from another cycle of treatment.

If the patient undergoes another operation or round of radiation without considering the impact on the patient’s intellect, mobility, and dignity, the patient may suffer a lot.

Involving the Patient in Conversation:

In neuro-oncology shared decision-making is important.  Patients and families should be included in all stages of the therapeutic decision-making process, not merely told about them.

Doctors must deliver information honestly: the prognosis, the realistic aims of each treatment, and the side effects may occur—in unambiguous terms; including the risk of seizures, memory loss, personality problems, and increasing dependence.

Once patient is provided a complete picture, many will shift their attention and would rather show signs of positive acceptance.

Supportive and palliative care are not an afterthought.

Supportive care should begin at the time of diagnosis and not after all the curative options have been exhausted.  Symptom control, pain management, seizure prevention, and cognitive support are just as important as the chemotherapy regimen.

Palliative care must be initiated early, this can enhance the quality of life and even survival in some patients.  This enables the patient to alleviate suffering, regulate neurological decline, and assist families in navigating complicated emotional terrain.

In neuro-oncology, where the disease frequently impairs independence, movement, and cognition, a strong support system by physiotherapists, speech therapists, occupational therapists, psychologists, and palliative care specialists—is essential and not just an option.

Need to shift the focus

The transition from active treatment, to comfort-oriented care should be managed with compassion, honesty, and respect. Patients may assume that choosing comfort will entail withdrawal of medical support. On the contrary, they can expect to receive a distinct sort of care, based on presence, relief, and dignity.

Critical care in neuro-oncology lies at the confluence of medicine, ethics, and humanism.  The goal is not simply to battle malignancies or extend survival time.  It is to guide patients through an intense reality, with compassion and skill.

Balancing aggressive treatment with quality of life does not imply selecting one over the other; rather it entails integrating both wisely and continuously. We must acknowledge that every scan and treatment decision is being made by a person who is hoping to live meaningfully.

Dr Divyesh Ahir, Consultant Neurosurgery, HCG Hospitals, Bhavnagar