Remembering Neil Peart and Understanding Glioblastoma

Three and a half years, kept quiet

Neil Peart drummed for Rush and wrote the band's lyrics for more than four decades. He died on January 7, 2020, in Santa Monica, California, at the age of 67.

CBS News reported that the cause was glioblastoma, a brain tumor, and that he had lived with it for three and a half years. His surviving bandmates called him their "soul brother and band mate of 45 years." They asked for privacy, and they asked anyone wishing to pay respects to give to cancer research instead.

He told almost no one while he was ill. That was his choice, and it is the last thing this page will say about him personally. The rest is about the tumor.

What glioblastoma is

Glioblastoma is a glioma, meaning it grows from the brain's supporting cells rather than from nerve cells themselves. The National Cancer Institute classifies it as WHO grade IV, the most aggressive grade assigned.

Brain cancer is uncommon. The American Cancer Society projects 24,740 new cases of cancer of the brain and other nervous system in the United States for 2026, along with 18,350 deaths, and NCI's SEER Stat Facts page carries that projection. SEER puts the rate at 6.1 new cases per 100,000 people per year, and lists ages 65 to 74 as the most common range at diagnosis. Peart was diagnosed younger than that.

Among tumors that start in the brain, though, this family is not rare at all. NCI notes that glioblastoma and anaplastic astrocytomas together account for 38 percent of primary brain tumors.

How a brain tumor announces itself

Symptoms depend almost entirely on where the tumor sits and what that region of brain does. NCI's patient guidance lists the common signs, and the phrasing of the first one is worth reading twice: "Morning headache or headache that goes away after vomiting."

The rest of the list is seizures, vision and hearing and speech problems, loss of appetite, frequent nausea and vomiting, changes in personality or mood or focus or behavior, loss of balance and trouble walking, weakness, and unusual sleepiness.

Seizures deserve special attention. NCI's clinician guidance reports that about 70 percent of patients with primary tumors in the brain tissue itself develop seizures at some point.

When to get checked

None of these signs means cancer, and most turn out to be something else. All of them are worth a same-week appointment, and the first two are worth an emergency room.

• A first-ever seizure at any age, including brief staring spells or one limb jerking
• Sudden weakness, numbness, or speech trouble on one side, which needs immediate care
• A headache that is worst on waking, or that eases after you vomit
• A headache pattern that is genuinely new for you, and that is getting worse week over week
• Double vision, a shrinking field of vision, or new hearing loss on one side
• New clumsiness, veering to one side when walking, or repeated falls
• A change in personality, focus, or behavior that people around you notice first

Getting to a diagnosis

Imaging comes first. NCI states that "MRI has superior soft-tissue resolution" for looking at these tumors, which is why MRI rather than CT is the mainstay.

Imaging alone cannot name the tumor. Tissue is required, and NCI notes that CT-guided or MRI-guided stereotactic techniques can be used to place a biopsy needle precisely. Stereotactic simply means the target is located using three-dimensional coordinates mapped from the scan.

The markers that change the numbers

Two molecular tests matter here. IDH refers to a pair of genes, and NCI reports that IDH1 and IDH2 variants are present in only 5 to 10 percent of glioblastomas. Most glioblastomas are therefore IDH wildtype, meaning the genes are unchanged.

MGMT is the more actionable test. It is a gene whose activity can be switched off by a chemical tag, a process called methylation. NCI reports that median overall survival was 18.2 months when MGMT was methylated, compared with 12.2 months when it was not. The tag makes tumor cells less able to repair the damage chemotherapy does.

What treatment involves

NCI is unusually specific about the sequence: "The standard treatment ... is surgery followed by concurrent radiation therapy and daily temozolomide, and then followed by six cycles of temozolomide."

Surgery aims to remove as much tumor as can be taken safely, but the brain sets hard limits on how much that is. Radiation follows, and NCI gives the dose as 60 Gy delivered in 2 Gy fractions over six weeks. Temozolomide is an oral chemotherapy taken every day during radiation, then in monthly cycles afterward.

That regimen was established by comparison, not by assumption. NCI reports that overall survival at three years was 16.0 percent with the combination, against 4.4 percent for radiation therapy alone.

Reading the survival figures honestly

SEER lists five-year relative survival for brain and other nervous system cancers at 32.9 percent, for cases from 2016 to 2022. That number should not be applied to glioblastoma. It pools every malignant CNS tumor, including slower types with far better outcomes, so it overstates the picture for grade IV disease considerably.

The glioblastoma-specific figures NCI cites are the ones above: median overall survival measured in months, and three-year survival in the mid teens for the group treated with the full regimen. Those numbers come from trial populations enrolled years ago, and they describe groups rather than people.

Two things follow from that. Clinical trials are a mainstream option in this disease rather than a last resort, and it is fair to ask at diagnosis what is open. Palliative care, meaning specialized help with symptoms, can also run alongside cancer treatment from the start rather than replacing it later.

Sources

• https://www.cbsnews.com/news/neal-peart-rush-death-drummer-and-lyricist-dead-age-67-after-battling-brain-cancer-2020-01-10/
• https://www.cancer.gov/types/brain/hp/adult-brain-treatment-pdq
• https://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq
• https://seer.cancer.gov/statfacts/html/brain.html
• https://www.cancer.org/research/cancer-facts-statistics.html