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Frequently Asked Questions About Brain Tumors and Treatment
by Dr. Arenson
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Do I have an incurable type of brain tumor? |
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 Curability
of brain tumors depends on many factors including the type of
tumor, its location, its surgical accessibility, the age, general
health and neurological condition of the patient, the patient’s
living situation and the approach to treatment, i.e. aggressive
or not. My approach is to treat with the intent to cure whenever
that goal is achievable, even if the chances are slim. This
approach leads to longer-term survival and a chance for cure
even for the most malignant of brain tumors. Such an approach
also leads to better preservation of neurological function and
quality of life.
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How will taking an aggressive approach to treatment
affect my quality of life, since I might not survive? |
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We
are convinced that the main threat to quality of life in patients
with central nervous system tumors is the tumor itself, seldom
the treatment. If the tumor grows, it is certain to cause major
functional changes such as changes in speech, thinking and memory,
and movement. Therefore, treatment, if successful in controlling
the growth of the tumor, even if it has side effects, is more
likely to preserve or improve quality of life than to degrade
it. Of course, there are some patients who tolerate treatment
poorly. In these cases, rather than continuing with intolerable
side effects, we modify the treatment until it is tolerable.
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How important is it to remove all of the brain tumor? |
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In
the case of high-grade tumors such as Grade III or Grade IV
astrocytoma (glioblastoma) or high-grade oligodendrogliomas,
surgical removal is crucial. Removal of more than 90% increases
the chance for long-term survival. Certain centers are better
equipped with the technology, philosophy and expertise to achieve
this goal. In my practice, we do everything possible to achieve
a complete response in which there is no tumor detectable by
MRI scan. If we can achieve this using combined surgery, radiation
therapy, chemotherapy and biological therapy, we have a chance
to cure the patient.
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What is the best treatment available
for my tumor? |
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At
the present time there is no established best treatment program
for this disease. What is crucial in making a decision about
where to be treated and what treatment to choose is to find
a place that offers a comprehensive program with a multidisciplinary
team of professionals who commit most or all of their time to
treating patients with central nervous system tumors. Such places
are much more likely to take an aggressive approach to treatment,
beginning with surgery and continuing with radiotherapy, chemotherapy
and biological therapy. It is also important to select doctors
who are flexible enough to adapt their treatment to the individual
patient’s needs rather than relying on rigid standards
and protocols.
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What do you and your program do to help support brain
tumor patients and their families?
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In
our program, we believe that supportive care is equal in importance
to the medical treatment component. We therefore offer a variety
of services to help patients and families which are not usually
found in medical practices
These include a monthly support group for patients and caregivers,
a monthly interfaith healing service led by me, a social worker
who is also our patient care coordinator who can help with
a variety of life issues, a program assistant who provides
frequent communication and information to our families and
organizes our monthly interdisciplinary conferences, nutritional
counseling, neuropsychologists to assess cognitive function
and provide counseling, massage therapy and an annual “Celebration
of Life” program in the Spring.
We also have active participation in a program called “Reel
Recovery” which provides fly-fishing experiences for
men with cancer. We are particularly committed to helping
patients feel connected to each other and, through our healing
service, to a higher power, which we believe greatly improves
the chances for a better outcome.
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What should I do about the alternative approaches that
I have heard so much about, and how should I deal with people
who are pushing me to explore these approaches? |
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I
tell my patients that it is important for them and for their
treating physicians to be open-minded. I seldom tell my patients
not to do some alternative treatment that they are interested
in. However, medicine must be approached as scientifically as
possible in order to assure patients that their treatment is
both safe and effective. Therefore, I emphasize those alternative
approaches that are more concerned with the motivational and
spirtitual needs of healing rather than those treatments where
actual medicine is used. Unproven medicines can be harmful and
can interfere with more proven treatments. Nevertheless, I work
with people through this problem with an eye toward individualizing
their care and providing what seems to work best for each patient. |
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— Edward B. Arenson,
M.D.
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