Palliative care for brain tumor patients at the end of life also is preventive medicine that involves anticipating and getting the jump on functional decline, said Dr. Christian T. Sinclair, a palliative care and hospice physician.
“Our job is to maximize benefits for the patient and family by discussing alternative services that are available and getting physical or occupational therapy involved early to strengthen the patient as much as possible,” said Dr. Sinclair, with Kansas City Hospice and Palliative Care. Although little can be done to slow functional decline, supplementing a corticosteroid with short-term methyl-phenidate can help increase energy and help cognition, he said.
“Start methylphenidate at 5 mg in the morning and 5 mg at noon. You'll know within a day if it works. If it does, go to 10 mg b.i.d. and top out at 30 mg a day. If the patient gets jittery and anxious, you may want to discontinue the drug,” he said.
Dr. Sinclair's “simple medication regimen at the end of life” was presented as an example: Dexamethasone 4 mg by mouth b.i.d., valproic acid 500 mg by mouth b.i.d., subcutaneous Lovenox daily, morphine ER 15 mg by mouth b.i.d., and morphine 5 mg by mouth every 2 hours p.r.n. for pain. And, he emphasized, some of these doses exceed FDA's normal dosage recommendations, therefore always use the lowest effective dose.
Anticipating functional decline is the goal care for a brain tumor patient at the end of life. DR. SINCLAIR