Care of the Adult Patient With a Brain Tumor

Mary P. Lovely, PhD RN CNRN; Christina Stewart-Amidei, PhD RN CCRN CNRN FAAN; Jean Arzbaecher, MS RN APN CNRN; Susan Bell, MS RN CNP CNRN; Mary Ellen Maher, MSN RN APN; Marilynn Maida, MSN RN APN CNRN; Kathleen Mogensen, MSN ANP-C; Gracia Nicolaseau, BSN RN CNRN

Approximately 66,240 people in the United States are estimated to be living with brain tumors in the United States currently (Ostrom et al., 2013). Ninety-three percent of all brain tumors occur in adults aged 20 years or older (Ostrom et al., 2013). Whereas the cause of brain tumors remains unknown, much more is currently known about the management of adult brain tumors than previously. Brain tumors may be classified as benign or malignant and primary or metastatic.

The American Association of Neuroscience Nurses' Nursing Management of the Adult Patient With a Brain Tumor (2014) is a first edition Clinical Practice Guideline (CPG). It is a more comprehensive approach to care of the adult patient with a brain tumor than the previous American Association of Neuroscience Nurses' publication, Guide to the Care of the Patient With Craniotomy Post-Brain Tumor Resection. The focus of the previous CPG was the immediate postoperative phase. The goal of Care of the Adult Patient With a Brain Tumor is to inform the reader about what is currently known about brain tumors in adults and to provide an evidence-based CPG for nurses and other clinicians from diagnosis to recovery or end of life. The guideline includes content on epidemiology, classification of brain tumors, pathophysiology, clinical features, diagnostic tests, surgical management, radiation therapy, chemotherapy, symptom management, psychosocial and educational needs of the patient and family, survivorship, and end-of-life care. Evidence-based nurse-specific recommendations provide detailed guidance for the nurse caring for the adult patient with a brain tumor.

This CPG was the culmination of an extensive literature review from publications dated 2000-2013, utilizing PubMed/MEDLINE, CINAHL, Cochrane Review, Embase, and Ovid Databases. Search terms included brain tumor, brain neoplasm, glioma, astrocytoma, glioblastoma, oligodendrogliomas, brain metastases, emergent care, diagnostic tests, acute care, magnetic resonance imaging (MRI), diffusion-weighted imaging, vasogenic edema, glucocorticoids, corticosteroids, Idh1 mutation, molecular pathogenesis, nephrogenic systemic fibrosis, cisplatin, carboplatin, procarbazine, vincristine, methotrexate, O6-metgylguanine-DNA methyltransferase (MGMT) promoter, 1p19q (chromosome) codeletion, carmustine wafer, embolization, cortical mapping, hemorrhage, hypertension, cerebrospinal fluid (CSF) leaks, seizures, infection, perilesional edema, brain metastasis, brain tumor radiation therapy, brain tumor chemotherapy, epilepsy, seizure, depression, anxiety, dysphonia, cognitive, fatigue, venous thromboembolism, anti-coagulation, support, quality of life, body image, sexuality, intimacy, nausea and vomiting, steroids, edema, rehabilitation, support, temozolomide, bevacizumab, brain tumor pathology, brain tumor classification, brain tumor incidence, brain tumor metastasis incidence, brain tumor etiology, brain tumor risk factors, brain tumor symptoms and brain tumor molecular biology, malignant brain tumor, survivor, end of life, symptom management, palliative care, and caregivers.

Nursing recommendations were developed from the existing evidence obtained from the scientific and clinical work of multiple disciplines. The recommendations were leveled based on the strength of the evidence in the literature. Nurse experts specializing in care of the adult patient with a brain tumor authored and reviewed this CPG.

Images and tables highlight important concepts and summarize key aspects of assessment, complication management, pharmacologic and nonpharmacologic management of symptoms, and chemotherapy. Care of the Adult Patient With a Brain Tumor is essential reading for the nurse who cares for the adult with brain tumor. The complete guideline is available as Supplemental Digital Content, at http://links.lww.com/JNN/A5.

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