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"Abstract. Purpose. Despite advances in therapies that offer improved. survival rates, clinical course of brain tumours leads to a. progressive functional deterioration in patients with. modifications in their psychological reaction to the. disease. Patients with brain tumours are rarely assessed. for quality of life and psychological variables, and even. fewer studies have assessed patients who have experienced. a recurrence of brain tumours. Therefore, the aim. of the present study is to investigate the patients with. recurrent brain tumours and their reaction to the illness.. Method We enrolled 81 patients with recurrent CNS. tumours. Karnofsky Performance Status scale (KPS) was. used to evaluate functional status of patients; the multidimensional. aspect of quality of life was assessed through. “Functional Assessment of Cancer Therapy-Brain” (FACTBr),. “Hospital Anxiety and Depression Scale” and “Psychological. Distress Inventory”. These were all used as tests. of psychological well-being.. Results Distress and almost all mean FACT-Br subscale. scores seemed to be significantly lower in patients, in. comparison with normative data. Surprisingly, the emotional. well-being mean score was significantly higher in our. recurrence sample than in patients with brain tumours at first. diagnosis. Anxiety seemed not to be influenced by a relapse. diagnosis; instead, depression was higher and differed. significantly from normative data. Low correlation between. KPS and FACT-Br total and some sub-scores was found.. Conclusions Apparent dissociation between patients' judgment. on their quality of life (bad except for emotional) and. their reported distress (low) is the most intriguing finding,. suggesting highly preserved coping strategies in the. emotional sphere, despite intact judgment and disease. awareness."

Actually guidelines require that patient must be informed about his condition so that he can choose the persons he wants to share these information with. Nonetheless, the caregiver usually gets an intermediary role in doctor-patient communication thus becoming the doctor's main conversation partner and claiming to be given more information than the patient himself. A more complex situation is about brain tumours patients sometimes affected by cognitive deficiencies, compromising their comprehension skills or their capability of keeping the information they are being given. A preliminary study allowed to submit separately to brain tumour patients and their family members a semi-structured interview. Although doctors communicate diagnosis and therapeutic plans, patients and their family members often do not seem to remember the information they are given. An important percentage of patients and their carers cannot tell correctly what they was said by the doctors. Only a minor percentage of patients do not want to know all details of their disease. Instead, most of the family members, would rather their beloved were given just partial information on their conditions or even not given information at all. Communication with patients and their carers requires careful re-negotiation in a multiple time-points, rather than a one-off communication episode.