Expert: Claes-Gustaf Nordquist, M.D. - 7/17/2008

Question
QUESTION: With a diagnosis of GBM,(only by MRI, biopsy showed necrosis), how can anyone predict an amount of time they think a patient will survive?  My dad was functioning very well(like a normal person), he went into the hospital and never was the same. For the past 6 months he just does not have strength, lost weight and sits and sleeps.  He needs a walker and wheelchair, can not bath himself or basically do anything anymore.  Why did this happen over night?  He can not even play cards or do crosswords anymore! He squints alot and stumbles.  What clincal signs will he have? One day he is soooo awake and then others days we argue to get him up.  He has no comprehension of time or days. Is it because they have him on 3mg of dexadron, 200 mg of keppra, fiber, and prilosec? Why is he like this and how long will he be like this?  He does not even know I am in the room sometimes or recogonize me his own daughter.

ANSWER: I think I have answered this before. A glioblastoma is best diagnosed by a biopsy or by surgical meterial. But also an MRI study will give many clues to the diagnosis and grade. The tumor destroys the brain volume it occupies and further damage may happen during surgery. If such changes happen in an important place devastating results may appear! That is probably what has happened here.  Part of his medication is given in order to keep his brain swelling down. Without it his symptoms would probably be even worse! Based on experience of this kind of tumors it can be said that his survival time at most can be measured in months, certainly not in several years. When he sleeps most of the time he will be approaching the end. Even more so when he slips into a coma.


---------- FOLLOW-UP ----------

QUESTION: Should we make him get up if he wants to sleep some days?  Also now that he is only taking 3mg of decadron he understands a bit more and is actually talking and communicating!  YIPPEEEEEEEEE.  Why is that?  I thought the less decadron you are on the worse you become, and that the dosage always needs to be increased when the end is approaching.  If this is the case, he must have a lot of time left because he is on a low dosage and has no headaches,nausua, vomiting NOTHING!  He is just tired and gets very very confused.  This is so confusing to me because I thought patients got worse not better, don't get me wrong he is not walking well(needs a walker most of the time),exhausted and just not the person he was before.  So I guess I am asking if a decadron dosage is Decreased and the patient shows a better quality of life does that mean thing are on a upswing because it is the decadron that is used to keep the swollen down.  And a little note here, he only had two weeks of headaches in January and none since and never had any other signs just forgetfullness.

Answer
Decadron (a cortison drug) does have side effects. His brain swelling (at least partly caused by surgery & radiation etc.) may have decreased on its own. In that case a smaller dose may indeed benefit him. Actually head ache or any other pain, nausea and vomiting are NOT usual symptoms in the later stages of brain tumors. Why force him to get up? It will not help him in any real way! The principal symptoms in late brain tumor cases are confusion, sometimes (NOT always) stroke like symptoms, sometimes even epileptic fits. Tiredness, fatigue & sleepiness. More and more sleep is very common until towards the end the patient drifts into a coma and then passes away. There is usually very little pain if indeed any!