Navigating Complexities in Management of Patients with Brain Tumors: An Integrated and Interdisciplinary Approach Led by Consultation Liaison Psychiatrists

Abstract: Gliomas, categorized as World Health Organization (WHO) grades II, III, and IV, represent the most common malignant brain tumors. Despite continual advancements in treatment approaches, gliomas are incurable. The median survival period for patients with low-grade gliomas is 5 to 15 years, for patients with grade 4 astrocytoma it is 12 to 18 months.

The diagnosis of primary brain tumors often subjects individuals to substantial physical, neurological, cognitive, and psychological distress, precipitating profound shifts in family dynamics, work capacities, and social interactions, sometimes leading to severe life disruptions, including housing instability. These challenges are often compounded by social determinants of health, such as socioeconomic status, access to healthcare, and social and economic policies, which can exacerbate disparities in health outcomes among brain tumor patients. Addressing these social determinants is crucial for providing equitable care and support for individuals facing brain tumor diagnoses.



Treating brain tumor patients necessitates a comprehensive, coordinated, and integrated approach that involves multiple disciplines working together seamlessly. This interdisciplinary approach ensures that patients receive optimal care tailored to their individual needs and circumstances.



Ethical challenges often arise in caring for brain tumor patients, necessitating a thorough understanding of ethical principles for effective care. Key tenets such as autonomy, justice, beneficence, and nonmaleficence guide decision-making in neuro-oncology, including discussions at the time of initial diagnosis, prognosis, treatment initiation (e.g., clinical trial participation), treatment-related quality of life, treatment cessation, hospice care, and management of behavioral and personality changes throughout the disease trajectory.



Led by three CL-psychiatrists and a neuro-oncologist from two academic cancer centers, this interactive clinical workshop aims to showcase an effective interdisciplinary approach to assessing and managing psychiatric symptoms in brain tumor patients and navigating the ethical challenges that arise from diagnosis to end-of-life care. Dr. De La Fuente will offer a comprehensive overview of the latest advancements in brain tumor treatment, shedding light on the challenges faced by neuro-oncologists, including burnout and career satisfaction. Dr. Espinel will explore the psychosocial ramifications of a brain tumor diagnosis, with a particular focus on the potential life changes and hardships, including housing instability, that may ensue. Through a series of case studies, Dr. Espinel will explore the experiences of four glioblastoma multiforme (GBM) patients who found themselves homeless following their diagnosis. Dr. Rueda-Lara will outline both pharmacological and non-pharmacological strategies for managing psychiatric symptoms among brain tumor patients. Dr. Alici will delve into the ethical dilemmas encountered in neuro-oncology patient care, spanning discussions on decision-making capacity, diagnosis and prognosis, treatment initiation, quality of life considerations, cessation of treatment, and hospice care. The session will culminate in a guided 20-minute clinical discussion, fostering active audience participation, with Dr. Alici moderating the final 10 minutes for a general Q&A session. This session underscores the pressing need for a holistic approach to patient care, one that addresses not only medical and psychiatric concerns but also the complex social needs of brain tumor patients.

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Learning Objectives:

• Describe the impact of psychosocial consequences of a brain tumor diagnosis.
• Participants will walk away with a nuanced approach to evaluating and assessing the psychiatric needs of brain tumor patients and the ethical challenges faced.
• A broad overview of pharmacological and non-pharmacological management strategies for brain tumors patients will be provided