Nursing Care of Glioblastoma Multiforme (GBM)

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Published: 01 December 2020

Glioblastoma multiforme (GBM) is the most malignant type of brain tumour (John Hopkins Medicine 2015).

What are GBMs?

GBMs are a type of glioma tumour, meaning they originate from the glial cells that support neurons in the brain. Specifically, GBMs are grade IV astrocytomas that originate from the highly vascular and quickly-reproducing astrocyte cells. GBMs account for approximately 17% of brain tumours (John Hopkins Medicine 2015; AANS 2015).

Among all glial tumours, GBMs are the most invasive (AANS 2015). They grow quickly and often spread to nearby brain tissue. Most GBMs develop ‘de novo’, meaning they start as grade IV tumours rather than developing from a lower grade (ABTA 2018).

GBMs develop in either the brain or spinal cord (Mayo Clinic 2020).

In most cases, patients will die from their tumour within 15 months of their diagnosis. GBMs are most common among those between 45 and 70 years of age and affect slightly more men than women (AANS 2015; ABTA 2018).

The cause of GBMs remains relatively unknown (Mayo Clinic 2020).

What are the Symptoms of a GBM?

The symptoms of a GBM are often caused by increased intracranial pressure, which occurs when the tumour grows too large and consequently compresses the healthy brain tissue or obstructs the flow of cerebrospinal fluid (UCSF 2018).

Common symptoms include:

  • Headaches;
  • Nausea and vomiting;
  • Loss of appetite;
  • Mood and personality changes;
  • Changes to cognitive function;
  • Seizures;
  • Speech difficulties; and
  • Vision issues (double or blurred vision).

(AANS 2015)

As with any type of ailment associated with the brain, symptoms may differ depending on the part of the brain affected (UCSF 2018).

How are GBMs Diagnosed and Treated?

ibrous astrocytes of brain tissue
Fibrous astrocytes of brain tissue showing many long and thin processes.

Diagnosis is most often achieved with an MRI and, if possible, a biopsy of the tumour (Mayo Clinic 2020).

If the patient has high intracranial pressure, the first line of treatment will focus on relieving this pressure. This often involves surgery such as a resection of the tumour, decompressive craniotomy or cerebral spinal fluid drainage. Raised intracranial pressure can also be medically managed by controlling hypertension, preventing seizures, controlling anaemia and administering steroids (Rangel-Castillo, Gopinath & Robertson 2008).

Like many other malignant brain tumours, GBMs can be treated with surgery, radiotherapy, chemotherapy or a combination of these treatments. However, most GBMs are difficult to fully remove through surgery because their borders are almost like tentacles, hence why other treatments such as chemotherapy and radiotherapy are often also needed (ABTA 2018).

My Patient has a GBM - What is Their Prognosis?

Even with optimal treatment, less than 25% of patients will live for up to two years and less than 10% for five years. Without treatment, life expectancy is under three months (Bruce 2019).

Children with a GBM generally have a longer life expectancy, with 25% living for five years or more (Watson 2018).

How Do I Look After a Patient With a GBM?

Caring for a patient with a GBM requires a holistic approach. You need to not only be involved in the medical treatment of the tumour but also provide psychosocial care. The emotional and psychological impact of being diagnosed with a GBM is quite substantial, particularly as these patients are facing a terminal brain tumour. They may also be physically and socially impacted by the changes the tumour has caused to their lifestyle due to symptoms such as memory problems and personality alterations.

It is recommended that a treatment plan be provided that caters to all aspects of the physical, medical and psychosocial impact of the GBM.

The medical treatment being provided to the patient, which may include chemotherapy, radiotherapy and medication management, will also impact the individual’s health more broadly. Any side effects from the medical management of a patient with a GBM must be swiftly dealt with. These may include nausea and vomiting, loss of appetite, fatigue, pain and skin abnormalities.

The patient’s family should also be involved in their treatment and, as a nurse, you will need to ensure that family members’ psychological health is maintained. This can become very difficult, especially as the tumour advances. Patients will quickly move from a fit and healthy lifestyle to one ravished by the diagnosis of a terminal brain tumour, to a discussion about palliative care.

As a nurse, you will play a pivotal role in the provision of both physical and psychosocial care throughout this period.


References

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