Managing brain metastases involves multiple approaches aimed at improving the patient's quality of life. Non-pharmacological strategies such as exercise and physiotherapy can help mitigate symptoms like weakness, myopathy, and fatigue, while advanced care planning plays a crucial role in determining the extent of future interventions.
As with all cases of PC the complete assessment of the patient is important and the presence of supportive team, family, surrounding spiritual community, This may impact on the patients, pain, side/effect profile
Pharmacological management
Chemo and Radio therapy
Treatment of the primary tumour and whole brain radio therapy, stereotactic radiotherapy can be effective in g improving symptoms, may increase swelling, thus Steroids may be important
Neutropaenia
Due to Chemo and Radiotherapy, need for granulocyte-colony stimulating factor
Depression and Anxiety
In general in PC cases a high incidence of this, using Antidepressants like Citalopram may be helpful
Anaemia
Erythropoeitin seen as a help but need months, is expensive, but thought to have Brain specific effect at neurones have EPO receptors
Analgesia
Morphine is often necessary, may increase confusion be difficult to ascertain if drug or met the cause of LOC
Anti-coagulation
Patients immoblie, DVT Prophylaxis may be given, treating of Cerebral Vein Thrombosis, be careful with harmorragic conversion of mets, Warfarin INR testing must again wieh risk benefit
Anti-Epileptic Drugs
Only once seizures occur, prophylactic not beneficial, Sodium Valproate the drug of choice, newer agents may be helpful
Steroids
effective for cerebral oedema, N&V lowest dose to achieve best symptom control, many side effects but risk benefit
Subtopic
Non-Pharmacological management
Social Workers play important roles
PC in these cases results in less admissions, investigations, interventions and increased home deaths
Advanced Care Planning can assist in determining future extent of interventions
assessing treatment regimes and effect on Quality of Life is important
Side effect of the Chemo, steroids and Cancer are weakness and myopathy and fatigue EXERCISE MAY benefit, physiotherapy as well
Main topic
Assessment
99% of cases will be incurable and thus Palliative Care is Imperative
20-40% of all Cancers may develop BM, due to improved Cancer therapy overall and increased survival
Pre-BM higher function, psychological state and Karnofsky performance status
