Palliative Care in Neuro-oncology: A Narrative Review of Principles and Practices

Neuropalliative care (NPC) is an interdisciplinary subspecialty that meets the needs of patients with life-limiting neurological disorders, especially brain tumours. These patients often face heavy symptom burdens such as seizures, cognitive decline, pain, fatigue, behavioural changes and loss of function, along with poor prognosis and high caregiver strain. Early NPC improves symptom control, aligns care with patient values and increases caregiver satisfaction. However, its use is inconsistent due to misconceptions, fragmented care and limited specialist training. The main principles in NPC include systematic symptom assessment, neurorehabilitation, psychosocial and spiritual support and advanced care planning. These steps need coordinated multidisciplinary involvement and are all aimed at helping with decision-making challenges from progressive neurologic decline. Anaesthesiologists help in perioperative care, the intensive care unit, pain management and palliative sedation. Innovations such as telehealth, home-based models, artificial intelligence-assisted predictive analytics, virtual reality for emotional support and advanced assistive communication devices offer opportunities to enhance care delivery. Global and national policy initiatives underscore the need for standardisation, equitable access and integration into routine neuro-oncology practice. This narrative review aims to explore foundational principles, practical strategies for clinical integration, barriers, and facilitators to implementation, to inform evidence-based practice and identify areas for further research in this evolving field.