RICHARD BECKER, MD, MED, FAHA
JAMIE DENLINGER, RN, BSN
MELISSA ERICKSON, MD
ALBERTO ESPAY, MD, MSC, FAAN
JONATHAN A. FORBES, MD
MLADEN GOLUBIC, MD, PHD
MARCIA KAPLAN, MD
MICHELLE KIRSCHNER, MSN, RN, ACNP, APRN-BC
ABIGAIL KOEHLER, BS
HEATHER RAVVIN MCKEE, MD
YEHUDIT ROTHMAN, PA-C
ALI J. ZARRABI, MD
SOMA SENGUPTA, MD, PHD, FRCP
The following compendium is designed to share information and resources for patients, their loved ones, and/or caregivers who have received a new brain tumor diagnosis or have previously been diagnosed with brain tumors. Some of the resources listed, including contact information referenced, are specifically available at the University of Cincinnati Medical Center/UC Health. If you are not located in the Greater Cincinnati area, please reach out to your preferred healthcare provider to inquire whether similar resources are available in your area.
BRAIN-TUMOR RELATED EPILEPSY
Seizures are the most common symptom caused by brain tumors.1 The overall frequency of seizures accompanying brain tumors ranges from 35% to 70%.2 Epilepsy in patients with brain tumors is considered the most significant risk factor for long-term disability.3 Epilepsy is defined as a patient having two or more seizures, or one seizure in a patient whose abnormal magnetic resonance imaging (MRI) or electroencephalography (EEG) indicates an increased risk for future seizures.4 Patients with a brain tumor and seizures meet the criteria for a diagnosis of epilepsy, and hence treatment for their epilepsy is warranted.5 There is not, however, any strong evidence that anti-seizure medication (ASM) prescribed to patients with brain tumors but no history of seizures is an effective treatment, so the decision to utilize that kind of medication should be guided by an assessment of individual risk factors and careful discussion with a neurologist.6 It is recommended to see a neurologist after a seizure occurs, as patients with brain tumor-related epilepsy present a complex therapeutic profile and require a unique and multidisciplinary approach. It is not unusual to have some amount of trial and error with anti-seizure medications, as there is not any one medication indicated for a particular brain tumor, and patients may require more than one medication for optimal seizure control. Importantly, full compliance with medication is essential.
Brain tumor-related epilepsy falls into the focal epilepsy category, given that a localized abnormality in the brain is the cause of the seizures. This allows for a broad range of treatment options for patients with brain tumor-related epilepsy, which includes broad-spectrum anti-seizure medications (ASMs) and ASMs used for focal epilepsy only. When deciding on a treatment option, it is critical to consider other medications, existing medical conditions, and potential side effects.7 ASMs that are often considered first when treating brain tumor-related epilepsy are ones with the fewest drug interactions, potential side effects, require minimal laboratory follow up, and are generic, so approval is easily obtainable, such as levetiracetam and lamotrigine. Levetiracetam can have a therapeutic effect that is relatively immediate, whereas lamotrigine requires an initial seven-week gradual dose increase to avoid a rash as a possible side effect, which limits immediate use. Lamotrigine, overall, is well-tolerated and typically the most highly recommended anti-seizure medication in older adults (>55 years).8 Levetiracetam is also typically well-tolerated, but potential side effects can include negative effects on mood, fatigue, and rarely could cause cytopenia (low blood cell count). Oxcarbazepine is another medication option, but it carries the possible side effect of hyponatremia (low sodium), particularly in older patients. Second-line brand name options include lacosamide, brivaracetam, or other broad-spectrum medications including valproic acid, zonisamide, or topiramate. Some medications may require cardiac screening with an electrocardiogram (EKG). Recommendations include the avoidance of an older category of ASMs that have stronger effects on drug metabolism and can interfere with anti-tumoral medications.9 The main ASMs in this category are phenytoin, carbamazepine, phenobarbital, and primidone.10 An epilepsy specialist would be able to provide the highest trained care for these patients and tailor their medication choice according to individual patient needs. Successful treatment is complete seizure freedom. Additional resources and information are available on the Epilepsy Foundation’s website: www.epilepsy.com.
DEPRESSION FOLLOWING BRAIN TUMOR DIAGNOSIS
Any patient facing a brain tumor diagnosis can experience distress. Depression and anxiety are highly prevalent even among members of the general population who have no related underlying medical conditions. To develop a clearer understanding of the phenomena linking brain tumors, depression, and anxiety, patients should be asked if they had mood and anxiety symptoms that developed before a brain tumor diagnosis or afterward as a result of their diagnosis. Is there biologically mediated change in mood and anxiety-regulating mechanisms in patients with brain tumors, and if so, what mechanisms might cause such symptoms? Did these symptoms develop before the brain tumor was large enough to cause symptoms, or only after the tumor was discovered? And finally, if patients with brain tumors have significant mood changes and anxiety symptoms, how do we best treat them?
It has been noted that depressive symptoms in patients with primary brain tumors are independently associated with reduced quality of life and survival time.11 Researchers suggest that underlying infammatory activation modulated through proinflammatory cytokines might cause depression as they promote tumor growth and metastasis. Additionally, they suggest that the tumor microenvironment might render treatment for depression less effective. One study reported on a sample of 89 patients with brain tumors which showed that 28% of those patients met the criteria for major depression. Major depression was predicted by the location of the tumor in the frontal lobe, combined with sadness, lack of motivation, and family psychiatric history.12 Researchers attempted a meta-analysis of the course of patients with primary brain tumors but found obstacles to identifying these patients due to exclusion criteria such as cognitive impairment.13 Of the small sample they identified, existential distress was correlated with significant depression, anxiety, and overall worse quality of life. Depression was studied across a wide range of neurological conditions including tumors of the brain and spine in over 4,000 patients and researchers found that the highest prevalence of depression (over 30% of the sample) occurred in those with traumatic brain injury (TBI) and brain tumors.14 Another study looked at 159 patients undergoing craniotomy for tumor resection and found that 48% reported high levels of distress and nearly seven sources of cancer-related distress.15
In a retrospective chart review of 301 deceased patients with primary or metastatic brain tumors, Appleby et al. found that depression was the most common premorbid psychiatric symptom, followed by substance abuse and anxiety.16 Comorbid depression developed in 15% and anxiety developed in 12% of their sample. Depression was as likely to be reported in male and female subjects, while anxiety was 3 times more likely to develop in female subjects. 34 depressed subjects were prescribed antidepressant medications and only 12 met with a psychiatrist at some point during their illness. Premorbid depression and anxiety were highly predictive of worse symptoms after diagnosis. Their findings make clear a significant underestimation and under-reporting of mood and anxiety symptoms in brain tumor patients, as well as a lack of psychiatric assessment for many of these patients.
There are case reports of individuals with psychiatric illness in whom brain tumors are later discovered.17 These anecdotal reports do prove a coorelation between mood and anxiety problems, which are common, with brain tumor development nor do they suggest that brain imaging is recommended for depressed and anxious patients without focal neurological symptoms. On the other hand, primary care physicians and psychiatrists must maintain a high degree of suspicion if patients develop mood or anxiety symptoms with abrupt or late-onset when there are concurrent neurologic focal signs.
Once diagnosed, patients with brain tumors should be monitored for their level of distress, capacity to sleep, eat, concentrate, and maintain meaningful activities and relationships.18 Married patients may be better protected from distress and have reported only half as much anxiety as single patients.19 Supportive services should be offered early in the process of treatment, whether those embedded in oncology treatment centers or through community-supported agencies in many communities that ofer individual and group psychotherapy and psychoeducation both for the patient and their families. Often general supportive treatment approaches are adequate for relief. Eye movement desensitization and reprocessing (EMDR) treatment, originally developed as a treatment for posttraumatic stress disorder (PTSD), was found to be statistically significant over standard medical care for improving depression, anxiety, and anger in patients with glioblastoma multiforme.20 When psychological symptoms are severe, psychiatric evaluation is appropriate, but where this is not available, primary care physicians or oncologists should consider prescribing serotonergic antidepressants.21 For patients with more troubling symptoms, including insomnia and nausea, second-generation antipsychotics 20-50 mg of quetiapine and 2.5-5 mg of olanzapine taken at bedtime can provide significant relief.
RESOURCES FOLLOWING DIAGNOSIS
NURSE NAVIGATION
Many patients find themselves overwhelmed following a brain tumor diagnosis. It may be challenging to keep track of all the information provided during appointments, including the timeline of the treatment plan itself, while simultaneously juggling the stress of their new diagnosis. This is where a nurse navigator steps in. The main role of nurse navigation for brain tumor patients, or any other cancer type, is to ensure that the often disparate parts of the overall treatment team/plan are interconnected to ensure timely, complete, and quality care. The figure below shows a flow-chart of a typical treatment plan for newly diagnosed brain tumor patients.
An MRI is done with and without contrast
suggestive of a brain tumor
A neurosurgeon will remove as much
of the tumor as safely possible
If complete resection of the tumor is achieved and the pathology is consistent with a GBM, about four weeks of healing time with additional treatment is estimated
The patient sees radiation oncology for
radiation planning and neuro-oncology
for chemotherapy management and to discuss
possible clinical trials.
There are many aspects to a patient’s treatment plan. The plan often begins with an initial visit to a neurosurgeon. It is at this point that nurse navigation can make a stressful situation somewhat less stressful. A comprehensive approach to patient care includes a dedicated team member contacting the patient and/or their family after the initial appointments to follow-up on comprehension of the diagnosis and discussion of possible surgical interventions. Establishing a rapport with a team member at this stage builds trust and confidence in the health care system. A nurse navigator meets with patients and their families again after surgery to ensure that these patients are seeing the correct providers and are connected with resources to help them cope with the physical and emotional consequences of the tumor, and possibly, the surgery.
Nurse navigation also plays an essential role in post-treatment and survivorship. As the patient progresses beyond the active treatment stage, it is possible to lose these patients to follow-up. The nurse navigator is the member of the treatment team that reaches out to provide support and keep the patient in touch with the healthcare system.22
PRIMARY CARE
At the University of Cincinnati Medical Center (UCMC), a large percentage of cancer patients either did not have a primary care physician or felt that their primary care physicians were not well-versed in the long-term effects of their cancer treatment. Utilizing a model proposed by Dr. Larissa Nekhlyudov of the Brigham and Women’s Hospital, UCMC created an oncology primary care clinic that is embedded in the institution’s cancer center.23 The goal of the clinic is to provide comprehensive primary care for patients with a history of cancer. It is staffed by a family medicine physician with additional training and experience in cancer survivorship. The proximity to treatment specialists has helped facilitate communication, allowing for more coordinated care, and it has also helped prevent potential delays in treatment by monitoring such conditions as severe hyperglycemia and elevated blood pressure. Additionally, this hospital-based model allows for improved mental health services, including access to social workers and medication management for anxiety and depression, which are diagnoses that primary care physicians are well-suited to treat.
SURVIVORSHIP CARE
Survivorship care focuses on meeting the comprehensive needs of patients who have been diagnosed with tumors. Most often, it centers on cancer patients who have malignant tumors. However, for those with brain tumors, survivorship care can also include benign (non-cancerous) tumors along with malignant tumors. In fact, patients with a benign brain tumor may often have access to some of the same survivorship services as those living with a malignant brain tumor. This is because benign and malignant brain tumors impact a person’s overall health in similar ways. For this reason, the National Cancer Registry requires hospitals to track benign brain tumor patients together with their cancer patients.
According to the National Cancer Institute’s Office of Cancer Survivorship, “an individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. There are many types of survivors, including those living with cancer and those free of cancer.”24 Survivorship care moves beyond the treatment of the tumor itself, focusing instead on the mental, emotional, physical, and spiritual impact on the individual and the caregiver.
Historically, survivorship services were focused on the delivery of a “survivorship care plan” document at the end of active treatment. Over time, survivorship care has become more collaborative and now emphasizes ongoing supportive services for patients. As part of this shift, the survivorship world is now exploring the needs of patients during different phases of treatment such as receiving therapy with curative intent for new diagnoses, post active treatment (on or off maintenance therapy), or living with cancer as a chronic condition.25 The expansion of survivorship care has created diversity in the types and availability of care that are organized. Large academic centers often lead this process through survivorship research and innovative programs. At the University of Cincinnati Medical Center (UCMC), the Neuro-Oncology and Survivorship programs have collaborated to create a Brain Tumor Survivorship Clinic. The goal of this clinic is to establish a relationship early on with the patient and caregiver to complete a comprehensive intake assessment and administer baseline cognitive testing, when appropriate.
Brain tumors can affect almost any region of the brain. Many tumors can then disrupt networks associated with cognitive function. As such, tumors can directly affect patients’ ability to communicate, socialize, interact, and even carry out daily activities. Some of the difficulties are hard to measure during a clinic visit and may require the evaluation of a neuropsychologist to determine the areas affected including visuospatial orientation, executive function, naming, memory, attention, or language.26 For this reason, the Neuro-Oncology clinic uses the National Institute of Health (NIH) Toolbox Cognition Battery (Age 12+) and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) batteries for cognitive testing. These batteries provide explicit details on which aspects of cognition are impaired. The data collected from patients is then interpreted by a neurocognition specialist.
Survivorship care for this population is focused on addressing the impact of the tumor on their quality of life and potential interventions.27 The patient is considered a partner in the process, and self-management is reinforced through the provision of resources for their journey. Overall wellness is promoted through education on the benefits of exercise, optimal nutrition, and mindfulness meditation. The clinic has been structured to highlight the specific effects of a brain tumor and its impact. For example, cognition is supported by determining potential areas of optimization including exploring the status of sleep, pain, and psychosocial inputs. Individuals are followed by the survivorship care team through telehealth and/or in-person visits to allow for the continued customization of recommendations.
Brain tumor patients and their caregivers must be aware that there may be helpful services and programs available through survivorship care. Health care providers within the survivorship program may have supportive care visits available, in which a global assessment of needs can be conducted, and then individuals can be connected to these services. The benefit of working with a survivorship team is that they are often familiar with the specific needs of the brain tumor population and can efficiently direct patients to the most appropriate services. If a health care system does not have a structured survivorship program, there may be resources through a regional academic center.
NAUSEA DURING BRAIN TUMOR TREATMENT
While undergoing treatment of a brain tumor, many patients will experience nausea as an unwelcomed side effect. A neuro-oncologist will typically prescribe an anti-nausea medication to take prior to the beginning of chemotherapy. Because there are many different classes and types of anti-nausea medications, it is important to work with a neuro-oncologist to find the right regimen. Even more important than the type of anti-nausea medication is the timing of the medication. It is much harder to control nausea once a patient is already feeling symptomatic. It is better to pre-empt nausea by taking anti-nausea medication before receiving chemotherapy.28 If a patient typically feels nauseous throughout their treatment, they should have one medication that is taken every 6-8 hours regardless of being symptomatic, as well as a second medication to take as needed for breakthrough nausea.
In addition to medications and medical management, there are also lifestyle changes and alternative treatments that may help with nausea. Eating bland, easy to digest foods and avoiding spicy, sweet, or fatty foods may help control nausea.29 Staying away from strong smells, eating cold or room temperature foods, and staying well hydrated can also help to keep nausea under control.30 Some alternative treatments may include peppermint tea or essential oils, ginger tea, real ginger ale, or ginger candies.31 Acupuncture, as well as acupressure bands, have been helpful for some people.32 If you are interested, talk with your doctor about getting a referral for acupuncture services at UC Health.
INTEGRATIVE MEDICINE FOR PATIENTS WITH BRAIN TUMORS
Thirty to eighty percent of patients diagnosed with cancer, including brain tumors, often use therapeutic modalities of integrative medicine. Their desire to actively contribute to the treatment of their disease and relieve symptoms associated with modern medical and surgical therapies seems to be the driving motivation.
The field of integrative medicine encompasses a spectrum of complementary evidence-based cancer care practices, alongside conventional cancer therapies. It combines the best of modern molecular medicine with known holistic therapies. The dedication to scientific research and evidence-based practice by practitioners of integrative medicine stands in sharp contrast to proponents of a variety of alternative treatments based on unsubstantiated claims that cancer can be cured exclusively through alternative therapies instead of conventional cancer treatments. Integrative medicine includes, among other things, lifestyle modifica-tions, mind-body and movement practices, and different modalities from traditional medical systems such as acupuncture and natural products (herbs, vitamins, minerals, and probiotics). The focus of these integrative therapies is to engage patients with their self-care, include their families as active participants throughout treatment and survivorship, facilitate posi-tive behavior changes, help manage cancer-related symptoms, and improve quality of life.
Health challenges are frequently encountered by patients affected by brain tumors, such as fatigue, pain, sleep difficulties, neuropathy, and anxiety. These challenges can often be alleviated by therapeutic modalities of integrative medicine. At the University of Cincinnati Center for Integrative Health and Wellness, we use a spectrum of therapies for these and other symptoms as recommended by the leading national professional cancer organizations. Those therapies include acupuncture, massage therapy, yoga, Tai Chi, music/art therapy, mindfulness meditation, and lifestyle medicine consultation with physicians.
Helping cancer patients cultivate health-promoting lifestyle habits is the foundation of current recommendations by the American Cancer Society, the American Institute for Cancer Research, and other organizations for expanding cancer treatment to include the promotion of overall long-term health. The inclusion of experts in nutrition, exercise science, and behavioral change has been shown to have a beneficial impact on a wide range of health outcomes. For example, adherence to a predominantly plant-based eating pattern that is rich in vegetables, whole grains, legumes, and fruits, with minimal consumption of processed foods, sugars, alcohol, and red and processed meats is considered a cornerstone of care for cancer survivors. Dietary patterns that reduce inflammation, such as the Mediterranean diet and other plant-based diets, may also reduce fatigue.
The National Comprehensive Cancer Network Guidelines recommend the use of acupuncture for pain, fatigue, nausea, and vomiting. Massage therapy has been shown to reduce cancer-related fatigue, pain, psychological stress, and to improve mood. Regular practice of mindfulness-based techniques can lead to decreased fatigue, depression, anxiety, chronic stress, and pain, to improved sleep and quality of life in general. It is also critical in the development and maintenance of health-promoting lifestyle habits and the avoidance of risky behaviors, such as smoking and alcohol consumption.
Compelling evidence supports cancer patients’ use of meditative movement practices such as Tai Chi and yoga for improving the quality of emotional health, sleep, balance, and for reducing the risk of falls. Considering the well-demonstrated benefits of physical activity for cancer survivors (increased vigor and vitality, better sleep, improved quality of life, cardiorespiratory fitness, decreased depression, anxiety, and fatigue), yoga and/or Tai Chi practice could be particularly helpful for patients who are weak and too fatigued to engage safely in physical activity. Although continuous, rigorously designed research on integrative therapies and self-care practices is necessary, the currently available knowledge forms a solid basis for sorely needed explorations on the best ways to widely implement such therapies in everyday clinical practice in a sustainable and equitable manner.33
ADDRESSING THE SYMPTOMS: PALLIATIVE CARE
Palliative care, also known as supportive care, is both an approach to care and a medical subspecialty that addresses the symptoms and stress of a serious illness, such as brain tumors. It is appropriate at any age or any stage in a serious illness and is based on the needs of the patient rather than the patient’s prognosis.34 More specifically, palliative care assesses and addresses physical, intellectual, social, emotional, and spiritual needs by anticipating, preventing, and alleviating suffering throughout the contin-uum of an individual’s illness.35 Palliative care is provided by a specially trained interdisciplinary team of doctors, nurses, and other specialists, such as social workers and chaplains, who work with the patient’s other doctors, specifically neurologists and oncologists, to provide an extra layer of support.36 Over two decades of evidence supports the use of palliative care across care settings, from the hospital to the clinic, to improve the quality of life of seriously ill patients and their families.37 Furthermore, emerging evidence suggests that when palliative care is provided in the outpatient setting to patients with advanced cancers, the patient’s prognosis may also improve.38
Patients with brain tumors can experience symptoms that can impact their quality of life including headaches, insomnia, fatigue, cachexia, altered mental status, and cognitive impairment.39 Furthermore, patients may experience isolation, anxiety, depression, demoralization, and existential distress, particularly as some approach the end of life.40 Specialists in palliative care can identify constellations of physical symptoms and emotional distress and tailor treatment plans for individual patients with brain tumors. Furthermore, teams can support patients’ loved ones and coordinate care with other healthcare professionals. The landscape of palliative care’s scope of practice is not yet standardized, and thus both the scope and practice of palliative care are variable across the United States.41 For this reason, patients and family members should ask their healthcare providers about how to access palliative care services and what services are specifically offered when confronting a serious illness such as a brain tumor.
Depending on the state in the US, guidelines regarding marijuana use differ. It is useful in brain tumor patients and has been said to improve, mood, appetite, and sleep. There is a pilot clinical trial to suggest that (Δ9) tetrahydrocannabinol (THC) might be useful in glioma patients.42 In many instances, marijuana palliates brain tumor patient symptoms more than opioids with fewer side effects. A reputable marijuana pharmacy should be used if the neuro-oncologist is not permitted to prescribe it in a given healthcare system.
HEART CONDITIONS
A relationship between brain tumors and heart conditions can take several forms. First, health conditions like high blood pressure, high cholesterol, and diabetes, or risky behaviors such as smoking contribute to the hardening of the arteries, also referred to as atherosclerosis. They can also lead to a heart attack, which might require a stent or bypass surgery, or a stroke, which can cause difficulty with speaking, walking, and coordination and balance, or a weakened heart muscle.43 Second, brain tumors, particularly large tumors associated with swelling in the brain itself, cause high blood pressure and either a slow or irregular heart rhythm. Third, tumors within specific parts of the brain can alter the heart and circulation’s abilities to regulate heart rate and blood pressure in response to changes in posture (lying, sitting, or standing) or the environment (heat, humidity, and cold conditions). As a result, the heart can beat very fast (>100 beats per minute) when standing, or the blood pressure can either increase when lying down or suddenly drop when sitting, standing, or walking. Symptoms can develop such as heart racing, palpitations, sweating, worsening headaches, dizziness, or loss of consciousness.44 Finally, some but not all cancer-related treatments, such as chemotherapy or immunotherapy, have side effects that can cause cardiomyopathy, an increase or decrease in blood pressure, alterations in heart rate or rhythm, or can heighten the blood’s ability to form blood clots. The latter is the proximate cause of heart attack, stroke, deep vein thrombosis, and pulmonary embolism.45
The most common signs or symptoms of a heart condition are chest pain, shortness of breath, rapidly progressive fatigue or impaired stamina, swelling of the legs, rapid weight gain, dizziness, lightheadedness or passing out with a change in posture, heart racing or fluttering, and worsening headache when lying down.
A heart specialist or cardiologist is often a member of the brain tumor team. She or he will perform an assessment by reviewing past medical history of heart conditions, risk factors for heart disease, and planned treatment. A thorough physical examination, electrocardiogram (EKG), and echocardiogram are common tests performed in this assessment. Other tests recommended by a heart specialist, often referred to as a cardio-oncologist, may include an MRI of the heart, Holter monitor (tape recording of the hearts rhythm), and a coronary computerized tomography (CT) angio-gram to evaluate for narrowing of one or more blood vessels providing blood and oxygen to the heart.
THE BASICS OF NAVIGATING CLINICAL TRIALS
It is common for brain tumor patients to join clinical trials, especially those diagnosed with glioblastoma multiforme (GBM). Clinical trials, though considered experimental, offer unique treatments for patients, and contribute to ongoing research investigating different treatments. Clinical trials typically have four steps, each focusing heavily on background research and data review to evaluate safety and effectiveness. The following flow chart diagram shows the different phases of a typical clinical trial, and what each step entails for researchers and research subjects.
PHASE 0 — Micro-dosing studies; speeds up drug/
immunotherapy development
PHASE 1—Testing a drug/immunotherapy in healthy
volunteers; evaluates the safety of a study drug
PHASE 2—Testing a drug/immunotherapy
in patient population; evaluates drug/immunotherapy
safety and efficacy
PHASE 3 — Usually requires many patients;
evaluates how well the new agent performs compared
to a readily available drug
The World Health Organization (WHO) is a prominent United Nations health agency that serves to promote global health. The WHO sets staging/grading requirements and identifies molecular or histological markers of brain tumors that can be used to further classify them. These classifications are often heavily considered when determining the course of treatment, as some molecular characteristics may be targetable by drugs or other anti-cancer therapies. 2021 WHO guidelines for brain tumors are a further reference, and many centers perform Caris or Foundation One sequencing of more aggressive brain tumors to help guide future therapy options. The discussion of molecular signatures is not the purpose of this book. Recently, the 5th edition of the World Health Organization Classification of Tumors of the Central Nervous System was released, where the WHO amended their guidelines to update the classifications of brain tumors.46 WHO guidelines are extremely relevant for GBM clinical trials because these trials are based on these guidelines. Patients or their caregivers can explore available clinical trials on www.clinicaltrials.gov.
Clinicaltrials.gov is a database of all the clinical trials around the world. Patients can look up studies based on their condition/disease, location, or other parameters such as the investigational device/drug or name of the investigator. Advanced criteria that may narrow the search include the type or phase of the study, stage of recruitment, eligibility criteria, type of study intervention, or funding entity. Study-specific criteria such as the name of the researcher, study title, or identification numbers can also be searched. It is important to double check that the search contains the condition or disease of interest and the correct location (country, state, and/or city), otherwise, the search will include clinical trials that are unavailable in your area.
The status of the clinical trial is displayed next to the study title and states whether patients can join the study. A green “Recruiting” status means that the study is currently open, and patients may join. A green “Not yet recruiting” status means that the study may soon be opening and looking for patients to join. The conditions of research interest, the type of intervention being studied, and the location where the study is being conducted are also listed on the search page. Additional information, including a description of the research and who to contact about participation, can be found by clicking on the title of the study.
ENDNOTES
1. Marta Maschio et al., “Weight of Epilepsy in Brain Tumor Patients,” Journal of Neuro-Oncology 118, no. 2 (May 2014): 385-393. https://doi.org/10.1007/s11060-014-1449-7.
2. M.J. Glantz et al., “Practice Parameter: Anticonvulsant Prophylaxis in Patients with Newly Diagnosed Brain Tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology,” Neurology 54, no. 10 (May 2000): 1886–93. https://doi.org/10.1212/wnl.54.10.1886; Charles Vecht and Erik B. Wilms, “Seizures in Low- and High-Grade Gliomas: Current Management and Future Outlook,” Expert Review of Anticancer Therapy 10, no. 5 (May 2010): 663–69. https://doi.org/10.1586/era.10.48.
3. Marta Maschio et al., “Weight of Epilepsy in Brain Tumor Patients,” 385-393; M. Maschio et al., “Antiepileptics in Brain Metastases: Safety, Efficacy and Impact on Life Expectancy,” Journal of Neuro-Oncology 98 (2009): 109–16. https://doi.org/10.1007/s11060-009-0069-0.
4. Robert Fisher et al., “ILAE Official Report: A Practical Clinical Definition of Epilepsy,” Epilepsia 55, no. 4 (April 2014): 475–82. https://doi.org/10.1111/epi.12550.
5. M.J. Glantz et al., “Practice Parameter: Anticonvulsant Prophylaxis in Patients with Newly Diagnosed Brain Tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology,” 1886-93: Marta Maschio et al., “Management of Epilepsy in Brain Tumors,” Neurological Sciences 40, no. 10 (October 2019): 2217–34. https://doi.org/10.1007/s10072-019-04025-9; Allan Krumholz et al., “Evidence-Based Guideline: Management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society,” Neurology 84, no. 16 (April 2015): 1705–13. https://doi.org/10.1212/WNL.0000000000001487; Anne T. Berg, “Risk of Recurrence after a First Unprovoked Seizure,” Epilepsia 49 (2008): 13–18. https://doi.org/10.1111/j.1528-1167.2008.01444.x; J.F. Annegers et al., “Risk of Recurrence after an Initial Unprovoked Seizure,” Epilepsia 27, no. 1 (February 1986): 43–50. https://doi.org/10.1111/j.1528-1157.1986.tb03499.x; P. Jallon, P. Loiseau, J. and Loiseau, “Newly Diagnosed Unprovoked Epileptic Seizures: Presentation at Diagnosis in CAROLE Study. Coordination Active Du Réseau Observatoire Longitudinal de l’Epilepsie,” Epilepsia 42, no. 4 (April 2001): 464–75. https://doi.org/10.1046/j.1528-1157.2001.31400.x.
6. M.J. Glantz et al., “Practice Parameter: Anticonvulsant Prophylaxis in Patients with Newly Diagnosed Brain Tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology,” Neurology 54, no. 10 (May 2000): 1883-1893. https://doi.org/10.1212/wnl.54.10.1886. Elaine Wyllie, “Encephalopathic Generalized Epilepsy and Lennox-Gastaut Syndrome,” in Wyllie’s Treatment of Epilepsy: Principles and Practice, 6th edition (Philadelphia, PA: Wolters Kluwer, 2015), 272–83; I.W. Tremont-Lukats, et al. “Antiepileptic Drugs for Preventing Seizures in People with Brain Tumors,” Cochrane Database System Review no. 2 (April 2008): CD004424. https://doi.org/10.1002/14651858.CD004424.pub2.
7. Marta Maschio et al., “Management of Epilepsy in Brain Tumors,” 2217–34.
8. Hilba Arif et al., “Comparative Effectiveness of 10 Antiepileptic Drugs in Older Adults with Epilepsy,” Archives of Neurology 67, no. 4 (April 2010): 408–15. https://doi.org/10.1001/archneurol.2010.49.
9. Marta Maschio et al., “Management of Epilepsy in Brain Tumors,” 2217–34.
10. Emilio Perucca, “Clinically Relevant Drug Interactions with Antiepileptic Drugs,” British Journal of Clinical Pharmacology 61, no. 3 (March 2006): 246–55. https://doi.org/10.1111/j.1365-2125.2005.02529.x.
11. Angela Starkweather et al., “A Biobehavioral Perspective on Depressive Symptoms in Patients with Cerebral Astrocytomas,” Journal of Neuroscience Nursing 43, no. 1 (2011): 17–28. https://doi.org/10.1097/jnn.0b013e3182029859.
12. David Wellisch et al., “Predicting Major Depression in Brain Tumor Patients,” Psycho-Oncology 11, no. 3 (2002): 230–38. https://doi.org/10.1002/pon.562.
13. Ashlee Loughan et al., “Fear of Cancer Recurrence and Death Anxiety: Unaddressed Concerns for Adult Neuro-Oncology Patients,” Journal of Clinical Psychology in Medical Settings 28, no. 1 (2021): 16–30. https://doi.org/10.1007/s10880-019-09690-8.
14. Andrew Bulloch et al., “Depression—a Common Disorder across Broad Spectrum of Neurological Conditions: A Cross-Sectional Nationally Representative Survey,” General Hospital Psychiatry 37, no. 6 (2015): 507–12. https://doi.org/10.1016/j.genhosppsych.2015.06.007.
15. S. Goebel et al., “Distress in Patients with Newly Diagnosed Brain Tumours,” Psycho-Oncology 20, no. 6 (2011): 623–30. https://doi.org/10.1002/pon.1958.
16. Brian Appleby, Kristin K. Appleby, and Peter V. Rabins, “Predictors of Depression and Anxiety in Patients with Intracranial Neoplasms,” Journal of Neuropsychiatry and Clinical Neurosciences 20, no. 4 (2008): 447–49. https://doi.org/10.1176/jnp.2008.20.4.447.
17. Bendikt Habermeyer et al., “A Clinical Lesson: Glioblastoma Multiforme Masquerading as Depression in Chronic Alcoholic,” Alcohol and Alcoholism 43, no. 1 (2008): 31–33. https://doi.org/10.1093/alcalc/agm150; Despina Moise and Subramoniam Madhusoodanan, “Psychiatric Symptoms Associated with Brain Tumors: A Clinical Enigma,” CNS Spectrums 11, no. 1 (2006): 28–31. https://doi.org/10.1017/s1092852900024135.
18. Monika Janda et al., “Unmet Supportive Care Needs and Interests in Services among Patients with a Brain Tumour and Their Carers,” Patient Education and Counseling 71, no. 2 (2008): 251–58. https://doi.org/10.1016/j.pec.2008.01.020.
19. C.P. Kaplan, and M. E. Miner, “Relationships: Importance for Patients with Cerebral Tumours,” Brain Injury 14, no. 3 (2000): 251–59. https://doi.org/10.1080/026990500120727.
20. Monika Szpringer, Marzena Oledzka, and Benedikt L. Amann, “A Non-Randomized Controlled Trial of EMDR on Affective Symptoms in Patients With Glioblastoma Multiforme,” Frontiers in Psychology 9 (May 2018): 785. https://doi.org/10.3389/fpsyg.2018.00785.
21. A.M. Bielecka, and E. Obuchowicz, “Antidepressant Drugs Can Modify Cytotoxic Action of Temozolomide,” European Journal of Cancer Care 26, no. 5 (2017). https://doi.org/10.1111/ecc.12551.
22. Rev. Diane Baldwin and Meredith Jones, “Developing an Acuity Tool to Optimize Nurse Navigation Caseloads,” Oncology Issues 33, no. 2 (2018): 17–25. https://doi.org/10.1080/10463356.2018.1427983.
23. Larissa Nekhlyudov, Denalee M. O’Malley, and Shawna V Hudson, “Integrating Primary Care Providers in the Care of Cancer Survivors: Gaps in Evidence and Future Opportunities,” The Lancet Oncology 18, no. 1 (2017): e30–38. https://doi.org/10.1016/S1470-2045(16)30570-8.
24. Ofce of Cancer Survivorship, “Statistics, Graphs and Definitions,” National Cancer Institute (NIH), accessed December 9, 2020, https://cancercontrol.cancer.gov/ocs/statistics#definitions.
25. Elyse R Park, Jeffrey Peppercorn, and Areej El-Jawahri, “Shades of Survivorship,” Journal of the National Comprehensive Cancer Network 16, no. 10 (2018): 1163–65. https://doi.org/10.6004/jnccn.2018.7071.
26. Lynne S. Padgett, Kathleen Van Dyk, Natalie C. Kelly, Robin Newman, Sherry Hite, and Arash Asher, “Addressing Cancer-Related Cognitive Impairment in Cancer Survivorship,” Oncology Issues 35, no. 1 (2020):52-57. https://doi.org/10.1080/10463356.2020.1692601; Kimberly Stump-Sutliff, Louise Cunningham, and Todd Gersten, “Brain Tumors: Coping with Thinking and Memory Problems,” University of Rochester Medical Center, n.d. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=34&contentid=18064-1.
27. Stacey L. Worrell et al., “Interdisciplinary Approaches to Survivorship with a Focus on the Low-Grade and Benign Brain Tumor Populations,” Current Oncology Reports 23, no. 2 (2021): 19. https://doi.org/10.1007/s11912-020-01004-8.
28. Rudolph M. Navari, and Matti Aapro, “Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting,” The New England Journal of Medicine 374, no. 14 (2016): 1356–67. https://doi.org/10.1056/NEJMra1515442.
29. Wolfgang Marx et al., “Chemotherapy-Induced Nausea and Vomiting: A Narrative Review to Inform Dietetics Practice,” Journal of the Academy of Nutrition and Dietetics 116, no. 5 (2016): 819–27. https://doi.org/10.1016/j.jand.2015.10.020.
30. Ibid.
31. Nuriye Efe Ertürk, and Sultan Tasci, “The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study,” Complementary Therapies in Medicine 56 (January 2021): 102587. https://doi.org/10.1016/j.ctim.2020.102587; Jane T. Hickok et al., “A Phase II/III Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Ginger (Zingiber Officinale) for Nausea Caused by Chemotherapy for Cancer: A Currently Accruing URCC CCOP Cancer Control Study,” Supportive Cancer Therapy 4, no. 4 (2007): 247–50. https://doi.org/10.3816/SCT.2007.n.022.
32. J. M. Ezzo et al., “Acupuncture-Point Stimulation for Chemotherapy-Induced Nausea or Vomiting,” Cochrane Database System Review no. 2 (April 2006): CD002285. https://doi.org/10.1002/14651858.CD002285.pub2.
33. Shelly Latte-Naor and Jun J. Mao, “Putting Integrative Oncology Into Practice: Concepts and Approaches,” Journal of Oncology Practice 15, no. 7 (2019): 7–14. https://doi.org/10.1200/JOP.18.00554; Dina M. Randazzo et al., “Complementary and Integrative Health Interventions and Their Association with Health-Related Quality of Life in the Primary Brain Tumor Population,” Complementary Therapies in Clinical Practice 36 (August 2009): 43–48. https://doi.org/10.1016/j.ctcp.2019.05.002; Farah Z. Zia et al., “The National Cancer Institute’s Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps,” JNCI Monographs 2017, no. 52 (2017): lgx005. https://doi.org/10.1093/jncimonographs/lgx005; Wendy Demark-Wahnefried et al., “Practical Clinical Interventions for Diet, Physical Activity, and Weight Control in Cancer Survivors,” CA: A Cancer Journal for Clinicians 65, no. 3 (2015): 167–89. https://doi.org/10.3322/caac.21265; Arash Asher, Jack B. Fu, Charlotte Bailey, and Jennifer K. Hughes, “Fatigue among Patients with Brain Tumors,” CNS Oncology 5, no. 2 (2016): 91–100. https://doi.org/10.2217/cns-2015-0008; Noël Arring, Debra L. Barton, Trevor Brooks, and Suzanna M. Zick, “Integrative Therapies for Cancer-Related Fatigue,” Cancer Journal 25, no. 5 (2019): 349–56. https://doi.org/10.1097/PPO.0000000000000396
34. Diane E Meier et al., “A National Strategy For Palliative Care,” Health Affairs 36, no. 7 (July 1, 2017): 1265–73, https://doi.org/10.1377/hlthaf.2017.0164.
35. “National Quality Forum,” National Quality Forum, accessed May 10, 2021, https://www.qualityforum.org/Home.aspx.
36. Meier et al., “A National Strategy For Palliative Care.”
37. Dio Kavalieratos et al., “Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-Analysis,” Journal of American Medical Association 316, no. 20 (November 22, 2016): 2104–14, https://doi.org/10.1001/jama.2016.16840.
38. Jennifer S. Temel et al., “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer,” The New England Journal of Medicine 363 (2010): 733–42, https://doi.org/10.1056/NEJMoa1000678; Jessica J. Fulton et al., “Integrated Out-patient Palliative Care for Patients with Advanced Cancer: A Systematic Review and Meta-Analysis,” Palliative Care 33, no. 2 (February 2019): 123–34, https://doi.org/10.1177/0269216318812633.
39. Havi Rosen et al., “The Benefit of Palliative Care on Brain Cancer Patients’ Quality of Life” (2018): 532–35; Thomas Noh and Tobias Walbert, “Brain Metastasis: Clinical Manifestations, Symptom Management, and Palliative Care,” Handbook of Clinical Neurology 149 (January 2018): 75-88; Eefe M Sizoo et al., “Symptoms and Problems in the End-of-Life Phase of High-Grade Glioma Patients,” Neuro-Oncology 12, no. 11 (November 2010): 1162–66, https://doi.org/10.1093/neuonc/nop045.
40. Katerine LeMay and Keith G Wilson, “Treatment of Existential Distress in Life Threatening Illness: A Review of Manualized Interventions,” Clinical Psychology Review 28, no. 3 (March 2008): 472–93; Kathleen E. Bickel et al., “An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness” Journal of Pain and Symptom Management 60, no. 3 (September 2020): 657–77, https://doi.org/10.1016/j.jpainsymman.2020.05.018.
41. Meier et al., “A National Strategy For Palliative Care”; Dio Kavalieratos, “Directing the Narrative to Define and Present Standardization in Palliative Care,” Journal of Palliative Medicine 22, no. 12 (December 2019): 1486–87, https://doi.org/10.1089/jpm.2019.0548.
42. M. Guzman et al., “A Pilot Clinical Study of Δ9-Tetrahydrocannabinol in Patients with Recurrent Glioblastoma Multiforme,” British Journal of Cancer 95, no. 2 (2006): 197–203. https://doi.org/10.1038/sj.bjc.6603236.
43. Salim S Virani et al., “Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association,” Circulation 143, no. 8 (February 23, 2021): e254–743, https://doi.org/10.1161/CIR.0000000000000950.
44. Magdalena Koszewicz et al., “Profile of Autonomic Dysfunctions in Patients with Primary Brain Tumor and Possible Autoimmunity,” Clinical Neurology and Neuro-surgery 151 (December 2016): 51–54, https://doi.org/10.1016/j.clineuro.2016.10.013.
45. National Institute of Health (NIH), “National Cancer Institute,” National Cancer Institute, accessed September 27, 2021, https://www.cancer.gov/.
46. Patrick Y. Wen and Roger J. Packer, “The 2021 WHO Classification of Tumors of the Central Nervous System: Clinical Implications,” Neuro-Oncology 23, no. 8 (2021): 1215–17, https://doi.org/10.1093/neuonc/noab120.
REFERENCES
Annegers, J. F., S. B. Shirts, W. A. Hauser, and L. T. Kurland. “Risk of Recurrence after an Initial Unprovoked Seizure.” Epilepsia 27, no. 1 (February 1986): 43–50. https://doi.org/10.1111/j.1528-1157.1986.tb03499.x.
Appleby, Brian S., Kristin K. Appleby, and Peter V. Rabins. “Predictors of Depression and Anxiety in Patients with Intracranial Neoplasms.” Journal of Neuropsychiatry and Clinical Neurosciences 20, no. 4 (2008): 447–49. https://doi.org/10.1176/jnp.2008.20.4.447.
Arif, Hiba, Richard Buchsbaum, Joanna Pierro, Michael Whalen, Jessica Sims, Stanley R. Resor Jr, Carl W. Bazil, and Lawrence J. Hirsch. “Comparative Effectiveness of 10 Antiepileptic Drugs in Older Adults with Epilepsy.” Archives of Neurology 67, no. 4 (April 2010): 408–15. https://doi.org/10.1001/archneurol.2010.49.
Arring, Noël, Debra L. Barton, Trevor Brooks, and Suzanna M. Zick. “Integrative Therapies for Cancer-Related Fatigue.” Cancer Journal 25, no. 5 (2019): 349–56. https://doi.org/10.1097/PPO.0000000000000396.
Asher, Arash, Jack B. Fu, Charlotte Bailey, and Jennifer K. Hughes. “Fatigue among Patients with Brain Tumors.” CNS Oncology 5, no. 2 (2016): 91–100. https://doi.org/10.2217/cns-2015-0008.
Berg, Anne T. “Risk of Recurrence after a First Unprovoked Seizure.” Epilepsia 49 (2008): 13–18. https://doi.org/10.1111/j.1528-1167.2008.01444.x.
Baldwin, Rev. Diane and Meredith Jones. “Developing an Acuity Tool to Optimize Nurse Navigation Caseloads.” Oncology Issues 33, no. 2 (2018): 17–25. https://doir.org/10.1080/10463356.2018.1427983.
Bickel, Kathleen E., Cari Levy, Edward R. MacPhee, Keri Brenner, Jennifer S. Temel, Joanna J. Arch, Joseph A. Greer. “An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness.” Journal of Pain and Symptom Management 60, no. 3 (September 2020): 657–77, https://doi.org/10.1016/j.jpainsymman.2020.05.018.
Bielecka, A. M. and E. Obuchowicz. “Antidepressant Drugs Can Modify Cytotoxic Action of Temozolomide.” European Journal of Cancer Care 26, no. 5 (2017). https://doi.org/10.1111/ecc.12551.
Bulloch, Andrew G. M., Kirsten M. Fiest, Jeanne V. A. Williams, Dina H. Lavorato, Sandra A. Berzins, Nathalie Jette, Tamara M. Pringsheim, and Scott B. Patten. “Depression—a Common Disorder across Broad Spectrum of Neurological Conditions: A Cross-Sectional Nationally Representative Survey.” General Hospital Psychiatry 37, no. 6 (2015): 507–12. https://doi.org/10.1016/j.genhosppsych.2015.06.007.
Demark-Wahnefried, Wendy, Laura Q. Rogers, Catherine M. Alfano, Cynthia A. Thomson, Kerry S. Courneya, Jeffrey A. Meyerhardt, Nicole L. Stout, Elizabeth Kvale, Heidi Ganzer, and Jennifer A. Ligibel. “Practical Clinical Interventions for Diet, Physical Activity, and Weight Control in Cancer Survivors.” CA: A Cancer Journal for Clinicians 65, no. 3 (2015): 167–89. https://doi.org/10.3322/caac.21265.
Ertürk, Nuriye Efe and Sultan Tasci. “The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study.” Complementary Therapies in Medicine 56 (January 2021): 102587. https://doi.org/10.1016/j.ctim.2020.102587.
Ezzo, J. M., M. A. Richardson, A. Vickers, C. Allen, S. L. Dibble, B. F. Issell, L. Lao, M. Pearl, G. Ramirez, Ja Roscoe, J. Shen, J. C. Shivnan, K. Streitberger, I. Treish, G. Zhang. “Acupuncture-Point Stimulation for Chemotherapy-Induced Nausea or Vomiting.” Cochrane Database System Review no. 2 (April 2006): CD002285. https://doi.org/10.1002/14651858.CD002285.pub2.
Fisher, Robert S., Carlos Acevedo, Alexis Arzimanoglou, Alicia Bogacz, J. Helen Cross, Christian E. Elger, Jerome Engel Jr., Lars Forsgren, Jacqueline A. French, Mike Glynn, Dale C. Hesdorffer, B.I. Lee, Gary W. Mathern, Solomon L. Moshé, Emilio Perucca, Ingrid E. Scheffer, Torbjörn Tomson, Masako Watanabe, and Samuel Wieber. “ILAE Official Report: A Practical Clinical Definition of Epilepsy.” Epilepsia 55, no. 4 (April 2014): 475–82. https://doi.org/10.1111/epi.12550.
Fulton, Jessica J., Thomas W. LeBlanc, Toni M Cutson, Kathryn N. Porter Starr, Arif Kamal, Katherine Ramos, Caroline E. Freiermuth, Jennifer R. McDuffie, Andrzej Kosinski, Soheir Adam, Avishek Nagi, John W. Williams. “Integrated Outpatient Palliative Care for Patients with Advanced Cancer: A Systematic Review and Meta-Analysis.” Palliative Care 33, no. 2 (February 2019): 123–34, https://doi.org/10.1177/0269216318812633.
Glantz, M. J., B. F. Cole, P. A. Forsyth, L. D. Recht, P. Y. Wen, M. C. Chamberlain, S. A. Grossman, and J. G. Cairncross. “Practice Parameter: Anticonvulsant Prophylaxis in Patients with Newly Diagnosed Brain Tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology.” Neurology 54, no. 10 (May 23, 2000): 1886–93. https://doi.org/10.1212/wnl.54.10.1886.
Goebel, S., A.M. Stark, L. Kaup, M. von Harscher, and H.M. Mehdorn. 2011. “Distress in Patients with Newly Diagnosed Brain Tumours.” Psycho-Oncology 20, no. 6 (2011): 623–30. https://doi.org/10.1002/pon.1958.
Guzman, M., M.J. Duarte, C. Blazque, J. Ravina, M.C. Rosa, I. Galve-Roperh, C. Sanchez, G. Velasco, and L. Gonzalez-Feria. “A Pilot Clinical Study of Δ9-Tetrahydrocannabinol in Patients with Recurrent Glioblastoma Multiforme.” British Journal of Cancer 95, no. 2 (2006): 197–203. https://doi.org/10.1038/sj.bjc.6603236.
Habermeyer, Benedikt, Marcus Weiland, Ralf Mager, Gerhard A. Weisback, and Friedrich M. Wurst. “A Clinical Lesson: Glioblastoma Multiforme Masquerading as Depression in Chronic Alcoholic.” Alcohol and Alcoholism 43, no. 1 (2008): 31–33. https://doi.org/10.1093/alcalc/agm150.
Hickok, Jane T., Joseph A. Roscoe, Gary R. Marrow, and Julie L. Ryan. “A Phase II/III Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Ginger (Zingiber Officinale) for Nausea Caused by Chemotherapy for Cancer: A Currently Accruing URCC CCOP Cancer Control Study.” Supportive Cancer Therapy 4, no. 4 (2007): 247–50. https://doi.org/10.1093/alcalc/agm150.
Jallon, P., P. Loiseau, and J. Loiseau. “Newly Diagnosed Unprovoked Epileptic Seizures: Presentation at Diagnosis in CAROLE Study. Coordination Active Du Réseau Observatoire Longitudinal de l’Epilepsie.” Epilepsia 42, no. 4 (April 2001): 464–75. https://doi.org/10.1046/j.1528-1157.2001.31400.x.
Janda, Monika, Suzanne Steginga, Jeff Dunn, Danette Langbecker, David Walker, and Elizabeth Eakin. “Unmet Supportive Care Needs and Interests in Services among Patients with a Brain Tumour and Their Carers.” Patient Education and Counseling 71, no. 2 (2008): 251–58. https://doi.org/10.1016/j.pec.2008.01.020.
Kaplan, C. P. and M. E. Miner. “Relationships: Importance for Patients with Cerebral Tumours.” Brain Injury 14, no. 3 (2000): 251–59. https://doi.org/10.1080/026990500120727.
Kavalieratos, Dio. “Directing the Narrative to Define and Present Standardization in Palliative Care.” Journal of Palliative Medicine 22, no. 12 (December 2019): 1486–87, https://doi.org/10.1089/jpm.2019.0548.
Kavalieratos, Dio, Jennifer Corbelli, Di Zhang, J. Nicholas Dionne-Odom, Natalie C. Ernecoff, Janel Hanmer, Zachariah P. Hoydich, Dara Z. Ikejiani, Michele Klein-Fedyshin, Camilla Zimmermann, Sally C. Morton, Robert M. Arnold, Lucas Heller, and Yael Schenker. “Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-Analysis.” Journal of American Medical Association 316, no. 20 (November 22, 2016): 2104–14, https://doi.org/10.1001/jama.2016.16840.
Koszewicz, Magdalena, Slawomir Michalak, Malgorzata Bilinskaa, Slawomir Budrewicza, Mikolaj Zaborowskid, Krzysztof Slotwinskia, Ryszard Podemskia, and Maria Ejmaa. “Profile of Autonomic Dysfunctions in Patients with Primary Brain Tumor and Possible Autoimmunity.” Clinical Neurology and Neurosurgery 151 (December 2016): 51–54, https://doi.org/10.1016/j.clineuro.2016.10.013.
Krumholz, Allan, Samuel Wiebe, Gary S. Gronseth, David S. Gloss, Ana M. Sanchez, Arif A. Kabir, Aisha T. Liferidge, Justin P. Martello, Andres M. Kanner, Shlomo Shinnar, Jennifer L. Hopp, and Jacqueline A. French. “Evidence-Based Guideline: Management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society.” Neurology 84, no. 16 (April 21, 2015): 1705–13. https://doi.org/10.1212/WNL.0000000000001487.
Latte-Naor, Shelly and Jun J. Mao. “Putting Integrative Oncology Into Practice: Concepts and Approaches.” Journal of Oncology Practice 15, no. 7 (2019): 7–14. https://doi.org/10.1200/JOP.18.00554.
LeMay, Katerine and Keith G Wilson. “Treatment of Existential Distress in Life Threatening Illness: A Review of Manualized Interventions.” Clinical Psychology Review 28, no. 3 (March 2008): 472–93.
Loughan, Ashlee R., Autumn Lanoye, Farah J. Aslanzadeh, Audrey Ann Lois Villanueva, Rachel Boutte, Mariya Husain, and Sarah Braun. “Fear of Cancer Recurrence and Death Anxiety: Unaddressed Concerns for Adult Neuro-Oncology Patients.” Journal of Clinical Psychology in Medical Settings 28, no. 1 (2021): 16–30. https://doi.org/10.1007/s10880-019-09690-8.
Marx, Wolfgang, Nicole Kiss, Alexandra L McCarthy, Dan McKavanagh, and Liz Isen-ring. “Chemotherapy-Induced Nausea and Vomiting: A Narrative Review to Inform Dietetics Practice.” Journal of the Academy of Nutrition and Dietetics 116, no. 5 (2016): 819–27. https://doi.org/10.1016/j.jand.2015.10.020.
Maschio, Marta, Francesca Sperati, Loredana Dinapoli, Antonello Vidiri, Alessandra Fabi, Andrea Pace, Alfredo Pompili, Carmine Maria Carapella, and Tonino Cantelmi. “Weight of Epilepsy in Brain Tumor Patients.” Journal of Neuro-Oncology 118, no. 2 (May 2014): 385-393. https://doi.org/10.1007/s11060-014-1449-7.
Maschio, M., L. Dinapoli, S. Gomellini, V. Ferraresi, F. Sperati, A. Vidiri, P. Muti, and B. Jandolo. “Antiepileptics in Brain Metastases: Safety, Efficacy and Impact on Life Expectancy.” Journal of Neuro-Oncology 98 (2009): 109–16. https://doi.org/10.1007/s11060-009-0069-0.
Maschio, Marta, Umberto Aguglia, Giuliano Avanzini, Paola Banfi, Carla Buttinelli, Giudeppe Capovilla, Marina Maria Luisa Casazza, Gabriella Colicchio, Antonietta Coppola, Cinzia Costa, Filippo Dainese, Ornella Daniele, Roberto De Simone, Marica Eoli, Sara Gasparini, Anna Teresa Giallonardo, Angela La Neve, Andrea Maialetti, Oriano Mecarelli, Marta Melis, Roberto Michelucci, Francesco Paladin, Giada Pauletto, Marta Piccioli, Stefano Quadri, Federica Ranzato, Rosario Rossi, Andrea Salmaggi, Riccardo Terenzi, Paolo Tisei, Flavio Villani, Paolo Vitali, Lucina Carla Vivalda, Gaetano Zaccara, Alessia Zarabla and Ettore Beghi. “Management of Epilepsy in Brain Tumors.” Neurological Sciences 40, no. 10 (October 2019): 2217–34. https://doi.org/10.1007/s10072-019-04025-9.
Meier, Diane E., Anthony L. Back, Amy Berman, Susan D. Block, Janet M. Corrigan, and R. Sean Morrison. “A National Strategy for Palliative Care.” Health Affairs 36, no. 7 (July 1, 2017): 1265–73, https://doi.org/10.1377/hlthaf.2017.0164.
Moise, Despina and Subramoniam Madhusoodanan. “Psychiatric Symptoms Associated with Brain Tumors: A Clinical Enigma.” CNS Spectrums 11, no. 1 (2006): 28–31. https://doi.org/10.1017/s1092852900024135.
National Institute of Health (NIH). “National Cancer Institute.” National Cancer Institute, accessed September 27, 2021. https://www.cancer.gov/.
“National Quality Forum.” National Quality Forum, accessed May 10, 2021, https://www.qualityforum.org/Home.aspx.
Navari, Rudolph M. and Matti Aapro. “Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting.” The New England Journal of Medicine 374, no. 14 (2016): 1356–67. https://doi.org/10.1056/NEJMra1515442.
Nekhlyudov, Larissa, Denalee M O’Malley, and Shawna V Hudson. “Integrating Primary Care Providers in the Care of Cancer Survivors: Gaps in Evidence and Future Opportunities.” The Lancet Oncology 18, no. 1 (2017): e30–38. https://doi.org/10.1016/S1470-2045(16)30570-8.
Noh, Thomas and Tobias Walbert. “Brain Metastasis: Clinical Manifestations, Symptom Management, and Palliative Care.” Handbook of Clinical Neurology 149 (January 2018): 75-88.
Office of Cancer Survivorship. “Statistics, Graphs and Definitions.” National Cancer Institute (NIH), accessed December 9, 2020. https://cancercontrol.cancer.gov/ocs/statistics#definitions.
Padgett, Lynne S., Kathleen Van Dyk, Natalie C. Kelly, Robin Newman, Sherry Hite, and Arash Asher. “Addressing Cancer-Related Cognitive Impairment in Cancer Survivorship.” Oncology Issues 35, no. 1 (2020): 52-57. https://doi.org/10.1080/10463356.2020.1692601.
Park, Elyse R., Jeffrey Peppercorn, and Areej El-Jawahri. “Shades of Survivorship.” Journal of the National Comprehensive Cancer Network 16, no. 10 (2018): 1163–65. https://doi.org/10.6004/jnccn.2018.7071.
Perucca. Emilio. “Clinically Relevant Drug Interactions with Antiepileptic Drugs.” British Journal of Clinical Pharmacology 61, no. 3 (March 2006): 246–55. https://doi.org/10.1111/j.1365-2125.2005.02529.x.
Randazzo, Dina M., Frances McSherry, James E. Herndon, Mary L. Afronti, Eric S. Lipp, Charlene Flahiff, Elizabeth Miller, Sarah Woodring, Susan Boulton, Annick Desjardins, David M. Ashley, Henry S. Friedman, and Katherine B. Peters. “Complementary and Integrative Health Interventions and Their Association with Health-Related Quality of Life in the Primary Brain Tumor Population.” Complementary Therapies in Clinical Practice 36 (August 2009): 43–48. https://doi.org/10.1016/j.ctcp.2019.05.002.
Rosen, Havi, Rikesh Patel, Soma Sengupta, and Ali Zarrabi. “The Benefit of Palliative Care on Brain Cancer Patients’ Quality of Life,” (2018): 532–35.
Sizoo, Eefe M., Lies Braam, Tjeerd J. Postma, H. Roeline W. Pasman, Jan J. Heimans, Martin Klein, Jaap C. Reijneveld, and Martin J. B. Taphoorn “Symptoms and Problems in the End-of-Life Phase of High-Grade Glioma Patients.” Neuro-Oncology 12, no. 11 (November 2010): 1162–66, https://doi.org/10.1093/neuonc/nop045.
Starkweather, Angela R., Paula Sherwood, Debra E. Lyon, Nancy L. McCain, Dana H. Bovbjerg, and William C Broaddus. “A Biobehavioral Perspective on Depressive Symptoms in Patients with Cerebral Astrocytomas.” Journal of Neuroscience Nursing 43, no. 1 (2011): 17–28. https://doi.org/10.1097/jnn.0b013e3182029859.
Stump-Sutliff, Kimberly, Louise Cunningham, and Todd Gersten. “Brain Tumors: Coping with Thinking and Memory Problems.” University of Rochester Medical Center (n.d.). https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=34&contentid=18064-1.
Szpringer, Monika, Marzena Oledzka, and Benedikt L. Amann. “A Non-Randomized Controlled Trial of EMDR on Affective Symptoms in Patients With Glioblastoma Multiforme.” Frontiers in Psychology 9 (May 2018): 785. https://doi.org/10.3389/fpsyg.2018.00785.
Temel, Jennifer S., Joseph A. Greer, Alona Muzikansky, Emily R. Gallagher, Sonal Admane, Vicki A. Jackson, Constance M. Dahlin, Craig D. Blinderman, Juliet Jacobsen, William F. Pirl, J. Andrew Billings, and Thomas J. Lynch. “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer.” The New England Journal of Medicine 363 (2010): 733–42, https://doi.org/10.1056/NEJMoa1000678.
Tremont-Lukats, I. W., B. O. Ratilal, T. Armstrong, and M. R. Gilbert. “Antiepileptic Drugs for Preventing Seizures in People with Brain Tumors.” Cochrane Database System Review no. 2 (April 16, 2008): CD004424. https://doi.org/10.1002/14651858.CD004424.pub2.
University of Rochester Medical Center. “Brain Tumors: Coping with Thinking and Memory Problems.” In Adult and Children’s Health Encyclopedia. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=34&contentid=18064-1.
Vecht, Charles J. and Erik B. Wilms. “Seizures in Low- and High-Grade Gliomas: Current Management and Future Outlook.” Expert Review of Anticancer Therapy 10, no. 5 (May 2010): 663–69. https://doi.org/10.1586/era.10.48.
Virani, Salim S., Alvaro Alonso, Hugo J. Aparicio, Emelia J. Benjamin, Marcio S. Bittencourt, Clifton W. Callaway, April P. Carson, Alanna M. Chamberlain, Susan Cheng, Francesca N. Delling, Mitchell S.V. Elkind, Kelly R. Evenson, Jane F. Ferguson, Deepak K. Gupta, Sadiya S. Khan, Brett M. Kissela, Kristen L. Knutson, Chong D. Lee, Tené T. Lewis, Junxiu Liu, Matthew Shane Loop, Pamela L. Lutsey, Jun Ma, Jason Mackey, Seth S. Martin, David B. Matchar, Michael E. Mussolino, Sankar D. Navaneethan, Amanda Marma Perak, Gregory A. Roth, Zainab Samad, Gary M. Satou, Emily B. Schroeder, Svati H. Shah, Christina M. Shay, Andrew Stokes, Lisa B. VanWagner, Nae-Yuh Wang, and Connie W Tsao, “Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.” Circulation 143, no. 8 (February 23, 2021): e254–743, https://doi.org/10.1161/CIR.0000000000000950.
Worrell, Stacey L., Michelle L. Kirschner, Rhonna S. Shatz, Soma Sengupta, and Melissa G. Erickson. “Interdisciplinary Approaches to Survivorship with a Focus on the Low-Grade and Benign Brain Tumor Populations.” Current Oncology Reports 23, no. 2 (2021): 19. https://doi.org/10.1007/s11912-020-01004-8.
Wellisch, David K., Thomas A. Kaleita, Donald Freeman, Timothy Coughesy, and Jeffrey Goldman. “Predicting Major Depression in Brain Tumor Patients.” Psycho-Oncology 11, no. 3 (2002): 230–38. https://doi.org/10.1002/pon.562.
Wen, Patrick Y. and Roger J. Packer. “The 2021 WHO Classifcation of Tumors of the Central Nervous System: Clinical Implications.” Neuro-Oncology 23, no. 8 (2021): 1215–17, https://doi.org/10.1093/neuonc/noab120.
Wyllie, Elaine. “Encephalopathic Generalized Epilepsy and Lennox-Gastaut Syndrome.” In Wyllie’s Treatment of Epilepsy: Principles and Practice, 6th edition., 272–83. Philadelphia, PA: Wolters Kluwer, 2015.
Zia, Farah Z., Oluwadamilola Olaku, Ting Bao, Ann Berger, Gary Deng, Arthur Yin Fan, Mary K. Garcia, Patricia M. Herman, Ted J. Kaptchuk, Elena J. Ladas, Helene M. Langevin, Lixing Lao, Weidong Lu, Vitaly Napadow, Richard C. Niemtzow, Andrew J. Vickers, Xin Shelley Wang, Claudia M. Witt, and Jun J. Mao. “The National Cancer Institute’s Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps,” JNCI Monographs 2017, no. 52 (2017): lgx005. https://doi.org/10.1093/jncimonographs/lgx005.