Home Healthcare After Brain Tumour Surgery: A Glioblastoma Case From Gurgaon

Patient Background

Mrs. N.S. is a 64-year-old retired college lecturer living in Sushant Lok Phase 1, Gurgaon, with her husband. Her daughter also lives nearby and participates in her care. Before her illness, she was fully independent in all daily activities. She managed her household, read regularly, and maintained an active social life.

Her medical history included hypertension for about 10 years and hypothyroidism, both managed with oral medication. She had no previous neurological disease, no history of stroke, and no known family history of brain tumours.

How the Illness Began

Over roughly three months, her family noticed gradual changes. She started forgetting recent conversations and repeating the same questions. She struggled to recognise familiar routes while walking in her locality. Her headaches became more frequent, especially in the mornings.

Her family initially thought these were age-related memory changes. This is a common assumption and one of the reasons brain tumours in older adults are sometimes diagnosed later than ideal.

Over time, her concentration reduced further. She began having difficulty finding common words during conversations, a symptom called expressive aphasia. Her personality started shifting. She became more withdrawn and sometimes confused.

The turning point came when she experienced a generalized seizure at home. Her family immediately took her to a tertiary care hospital in Gurgaon, where further investigations confirmed the diagnosis.

Clinical Diagnosis

At the hospital, the medical team conducted a thorough evaluation.

Investigations Performed

• MRI Brain with contrast
• CT Brain
• EEG (electroencephalogram)
• Complete blood profile
• Detailed neurological examination
• Formal cognitive assessment
• Histopathology after surgical tumour removal

Diagnosis Confirmed

Based on imaging and histopathology, the diagnosis was Glioblastoma, WHO Grade IV. This is the most aggressive type of primary brain tumour in adults. It originates from glial cells and tends to grow rapidly.

For families wanting a deeper understanding of how brain tumours are diagnosed and treated surgically, our detailed guide on diagnosis and surgical treatment of brain tumours provides further reading.

Associated Clinical Findings

Alongside the primary diagnosis, the following conditions were identified:

Hospital Treatment

Mrs. N.S. underwent a right frontal craniotomy with tumour debulking. This is a major neurosurgical procedure where a portion of the skull is temporarily removed to access and reduce the tumour mass.

She was then moved to the Neuro ICU for close monitoring. During her 21-day hospital stay, she received:

• Anti-epileptic medication to prevent further seizures
• High-dose corticosteroids to reduce brain swelling
• Speech therapy sessions
• Physiotherapy for mobility and left-sided weakness
• Oncology consultation for further treatment planning
• Radiation planning
• Temozolomide chemotherapy initiation

Condition at Discharge

By the time of discharge, the surgical wound was healing. However, her neurological status remained significantly affected:

• Unable to remember events from the same day
• Required reminders for every medication dose
• Needed supervision during meals due to reduced appetite and mild coordination difficulty
• Occasionally could not recognise visitors
• Mild left arm and leg weakness persisted
• High risk of falls due to balance problems and weakness
• Episodes of confusion, more noticeable in the evenings and at night
• Dependent for medication management and financial tasks
• Required assistance with bathing and dressing

Why Home Healthcare Was Needed

Discharging a patient with Glioblastoma Grade IV to an unstructured home environment carries significant risk. The treating neuro-oncologist advised comprehensive home care for specific clinical reasons.

Home Care Plan by AtHomeCare

Based on the discharge summary and the neuro-oncologist’s recommendations, a structured home care plan was created. The plan was designed to address every identified clinical need while keeping the patient comfortable in her own home.

Skilled Home Nursing

A trained nurse was assigned to provide home nursing care. The nurse’s responsibilities included medication administration at correct times, blood glucose monitoring for steroid-induced diabetes, surgical wound observation and dressing, vital sign recording, and coordination with the treating oncologist for chemotherapy follow-up visits.

Full-Time Patient Attendant

A trained patient care attendant was deployed for 24-hour supervision. The attendant assisted with activities of daily living including bathing, dressing, toileting, and feeding. More importantly, the attendant provided continuous presence to manage seizure risk, prevent falls, and support the patient during confusion episodes, especially at night.

Physiotherapy at Home

A physiotherapist visited regularly to address the left-sided weakness and balance problems. The programme focused on physiotherapy at home in Gurgaon, including supervised walking, balance training, range-of-motion exercises for the left arm and leg, and safe transfer techniques. The goal was not full recovery of strength, but maintaining functional mobility for as long as possible and preventing complications of immobility such as joint contractures.

Speech and Cognitive Stimulation

Structured cognitive activities were introduced. These included simple word-finding exercises, memory games using familiar objects and family photographs, conversation practice, and orientation exercises (time, place, person). The approach was adapted from principles used in dementia and Alzheimer’s care at home, though the underlying cause here was different.

Nutritional Support

The nursing team worked with the family to prepare calorie-dense, easy-to-swallow meals. Eating was supervised to prevent choking. Intake was documented daily. The importance of nutrition and hydration in elderly care is well established, and it becomes even more critical during active cancer treatment.

Pressure Injury Prevention

Although the patient was not fully bedridden, her reduced mobility and nutritional status placed her at risk for pressure injuries. A repositioning schedule was followed, skin was inspected daily, and an appropriate mattress surface was arranged. Detailed guidance on pressure ulcer prevention in elderly home care was applied.

Seizure Safety Protocol

The home team was trained in seizure first aid. Medications were given on strict schedules. The environment was made safe: sharp edges padded, walking areas cleared, and the patient was never left alone near stairs or in the bathroom.

Family Caregiver Education

The husband and daughter were taught to recognise warning signs such as increased confusion, new weakness, seizure activity, wound changes, and signs of infection. They were also guided on how to assist with transfers safely. Choosing the right home caregiver and understanding their role is an important part of the process.

Oncology Follow-Up Coordination

The nursing team maintained a log of symptoms, medication responses, and functional changes. This log was shared with the treating oncologist at each follow-up visit, ensuring continuity between home care and hospital-based treatment.

Recovery Timeline

Documented Clinical Observations

The following tables summarize the functional changes observed during home care. These are based on direct nursing documentation and family-reported observations. Specific laboratory values and vital sign readings from hospital records are not reproduced here to protect patient confidentiality.

Functional Status Over Time

Care Interventions Delivered

Medical Author

Dr. Ekta Fageriya, MBBS

RMC Registration No.: 44780
Specialization: Geriatric Medicine
Clinical Experience: 7 Years

Supporting Clinical Documents

The following documents from the patient’s hospital course were referenced in preparing this case study. Specific patient identifiers and detailed report contents are not reproduced to maintain confidentiality.

Recovery Outcome

It is important to state clearly that Glioblastoma Grade IV remains an aggressive disease with a challenging prognosis. Home healthcare did not change the underlying diagnosis. What it did achieve was meaningful in the context of this patient’s quality of life and safety.

Mobility

The patient progressed from being at high risk of falls at discharge to walking indoors with supervision by month one. This mobility was maintained through month five. Physiotherapy prevented the rapid deconditioning that commonly occurs when brain tumour patients are discharged home without rehabilitation support.

Seizure Safety

No seizures occurred during the five months of home care. With a trained attendant present at all times and medication adherence ensured by the nursing team, this risk was managed effectively.

Nutrition

The moderately malnourished state at discharge improved steadily. Supervised feeding, diet modifications, and calorie tracking helped the patient tolerate her chemotherapy and radiotherapy better than she might have without nutritional support.

Cognitive and Communication Function

Short-term memory did not recover significantly, which is expected with this condition. However, structured cognitive stimulation and a consistent daily routine helped the patient participate in simple activities and maintain connection with her family. The evening confusion episodes became less frequent with a structured routine.

Medical Stability

There were zero hospital readmissions during the five-month period. For a patient with Glioblastoma on active treatment, this is a notable outcome. It suggests that the home care plan effectively addressed the most common post-discharge complications: infections, falls with injury, uncontrolled seizures, and medication errors.

Family Feedback

The family reported that having professional support at home reduced their anxiety significantly. The husband and daughter could participate in care without carrying the entire burden. They learned to manage daily routines and recognise when to seek medical advice.

Remaining Challenges

The underlying tumour continued to require active oncology management. Cognitive impairment persisted. The patient remained dependent for most activities of daily living. These are expected realities of Glioblastoma, and home healthcare was designed to work alongside these challenges, not eliminate them.

Key Clinical Learnings

Frequently Asked Questions

For Families Exploring Home Healthcare in Gurgaon