Brain tumor symptoms as antecedents to uncertainty: an integrative review.

AbstractPurpose: Uncertainty is a common experience within human cancer. For brain tumor patients, irregular symptom pattern and presentation may promote uncertainties about treatment response, prognosis, and life quality. We sought to identify the somatic symptom experience associated with primary and secondary brain tumors and the potential impact on illness-related uncertainty.Methods: An integrative literature search of Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed. Symptom data were excerpted into tables and reviewed critically against the broader uncertainty-focused oncology literature.Results: Twenty-one studies investigated a diverse range of brain tumor symptoms that persist through the now-expanding, post-treatment survival. While symptoms such as fatigue were common, antecedents and patterns were poorly characterized and inconsistent between and within categories of tumor.Conclusions and Implications: Symptom investigation is an emerging and rapidly developing area of neuro-oncology. The extent to which symptoms are familiar, predictable, and understandable can mitigate uncertainty. The unstable nature of symptoms across the trajectory of a brain tumor may be a significant corollary to illness-related uncertainty.Clinical Relevance: Because the majority of brain tumor patients cannot be cured of their cancer, understanding the symptom expanse and potential to promote uncertainty could inform alternative nursing strategies to reduce anxiety and distress, and to preserve life quality where cure is often unattainable.Key wordsSymptoms, primary brain tumors, metastatic brain tumors, uncertaintyDespite significant advances in treatment and survival, there remains substantial symptom burden associated with the diagnosis of a brain tumor. Subtle neurologic disability is often present, and for advanced disease, major consequences can include progressive functional impairment, cognitive decline, and death. Treatment of a brain tumor is generally palliative; surgical tumor debulking, radiotherapy, and chemotherapy are used alone and in combination to prolong life, decelerate neurologic impairment, and alleviate symptoms. However, many therapies consequently elicit severe secondary symptoms that can degrade quality of life (QoL; Lovely, 2004; Lovely, Miaskowski, &* Dodd, 1999). These symptoms are important to balance against absolute survival and other clinical benefits of treatment.SymptomsSymptoms and Brain TurmorsThe symptom experience for any individual patient is difficult to predict. Primary brain tumors (PBTs) evolve from and within central nervous tissue and are thus distina from the more prevalent metastatic (secondary) brain tumors (METs). Symptoms associated with PBTs and METs may differ according to the biology of infiltrative invasive disease in the former, and the collateral presence of systemic disease in the latter. Moreover, despite standard treatments, symptoms vary between and within categories of tumor as a function of grade, size, location, and histology (Lovely, 2004), in addition to complex anatomical and functional variants, such as speech lateralization. Throughout the disease, symptoms may wax and wane, disappear completely, or emerge latently, limiting reliable interpretation of symptoms as evidence for stabilization, remission, or recurrence of the tumor.Symptoms and UncertaintyThe Theory of Uncertainty in Illness (Mishel, 1988) posits that patients unable to infer symptom-based patterns have difficulty predicting outcomes, which promotes a state of uncertainty (Clayton, Mishel, &· Belyea, 2006). Accordingly, the inconsistent and ambiguous nature of symptoms likely engenders uncertainty in brain tumor patients. Although well characterized in other oncology samples (e.g., breast, prostate, and gynecologic cancers), uncertainty has not yet been evaluated in brain tumor patients using the principal scale developed by Mishel (1981). …