Aggressiveness of care at end of life in patients with high‐grade glioma

Abstract Background Patients with high‐grade glioma (HGG) face unique challenges toward the end of life (EoL), given their aggressive trajectory and neurologic deterioration. Aggressiveness of medical care at EoL has been identified as an important quality metric for oncology patients. At this time,...

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Autores principales:	Rebecca A. Harrison, Alexander Ou, Syed M. A. A. Naqvi, Syed M. Naqvi, Shiao‐Pei S. Weathers, Barbara J. O'Brien, John F. deGroot, Eduardo Bruera
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	cancer end of life glioma palliative care supportive care Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/e046fcbf01be4ef9ad2c508cd4b8d1c2
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spelling	oai:doaj.org-article:e046fcbf01be4ef9ad2c508cd4b8d1c22021-12-01T04:49:15ZAggressiveness of care at end of life in patients with high‐grade glioma2045-763410.1002/cam4.4344https://doaj.org/article/e046fcbf01be4ef9ad2c508cd4b8d1c22021-12-01T00:00:00Zhttps://doi.org/10.1002/cam4.4344https://doaj.org/toc/2045-7634Abstract Background Patients with high‐grade glioma (HGG) face unique challenges toward the end of life (EoL), given their aggressive trajectory and neurologic deterioration. Aggressiveness of medical care at EoL has been identified as an important quality metric for oncology patients. At this time, limited data exist around the nature of EoL care of patients with HGG. Methods Patients with HGG and palliative care (PC) referral seen between 2010 and 2015 were identified (N = 80). Of these, N = 52 met inclusion criteria. Random selections of patients with (1) HGG not referred to PC (n = 80), and (2) non‐CNS cancers with PC referral (n = 80) were identified for comparison. A composite score of aggressiveness of medical care at EoL was calculated for each patient from predetermined variables. A time of eligibility for PC was defined for each patient when predetermined criteria based on symptom burden, functional status, and prognosis were met. Results Among the patients analyzed with HGG referred to PC, 59.6% (N = 31) were referred as inpatients, and 53.8% (N = 28) were referred within the last 12 weeks of life. Patients with HGG had similar aggressiveness of care at EoL regardless of PC referral, and HGG patients had less aggressive care at EoL than patients with non‐CNS cancers (p = 0.007). Care was more aggressive at EoL in HGG patients who received late versus early PC referrals (p = 0.012). Motor weakness at time of eligibility (OR = 2.55, p = 0.002) and more disease progressions (OR = 1.25, p = 0.043) were associated with less aggressive care at EoL. Conclusions Early clinical‐ and disease‐related features predict the aggressiveness of medical care at EoL in patients with HGG. Formal PC consultation is used infrequently and suboptimally in patients with HGG. Our data suggest that the role of PC in improving EoL outcomes in HGG warrants further evaluation.Rebecca A. HarrisonAlexander OuSyed M. A. A. NaqviSyed M. NaqviShiao‐Pei S. WeathersBarbara J. O'BrienJohn F. deGrootEduardo BrueraWileyarticlecancerend of lifegliomapalliative caresupportive careNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Medicine, Vol 10, Iss 23, Pp 8387-8394 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cancer end of life glioma palliative care supportive care Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	cancer end of life glioma palliative care supportive care Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Rebecca A. Harrison Alexander Ou Syed M. A. A. Naqvi Syed M. Naqvi Shiao‐Pei S. Weathers Barbara J. O'Brien John F. deGroot Eduardo Bruera Aggressiveness of care at end of life in patients with high‐grade glioma
description	Abstract Background Patients with high‐grade glioma (HGG) face unique challenges toward the end of life (EoL), given their aggressive trajectory and neurologic deterioration. Aggressiveness of medical care at EoL has been identified as an important quality metric for oncology patients. At this time, limited data exist around the nature of EoL care of patients with HGG. Methods Patients with HGG and palliative care (PC) referral seen between 2010 and 2015 were identified (N = 80). Of these, N = 52 met inclusion criteria. Random selections of patients with (1) HGG not referred to PC (n = 80), and (2) non‐CNS cancers with PC referral (n = 80) were identified for comparison. A composite score of aggressiveness of medical care at EoL was calculated for each patient from predetermined variables. A time of eligibility for PC was defined for each patient when predetermined criteria based on symptom burden, functional status, and prognosis were met. Results Among the patients analyzed with HGG referred to PC, 59.6% (N = 31) were referred as inpatients, and 53.8% (N = 28) were referred within the last 12 weeks of life. Patients with HGG had similar aggressiveness of care at EoL regardless of PC referral, and HGG patients had less aggressive care at EoL than patients with non‐CNS cancers (p = 0.007). Care was more aggressive at EoL in HGG patients who received late versus early PC referrals (p = 0.012). Motor weakness at time of eligibility (OR = 2.55, p = 0.002) and more disease progressions (OR = 1.25, p = 0.043) were associated with less aggressive care at EoL. Conclusions Early clinical‐ and disease‐related features predict the aggressiveness of medical care at EoL in patients with HGG. Formal PC consultation is used infrequently and suboptimally in patients with HGG. Our data suggest that the role of PC in improving EoL outcomes in HGG warrants further evaluation.
format	article
author	Rebecca A. Harrison Alexander Ou Syed M. A. A. Naqvi Syed M. Naqvi Shiao‐Pei S. Weathers Barbara J. O'Brien John F. deGroot Eduardo Bruera
author_facet	Rebecca A. Harrison Alexander Ou Syed M. A. A. Naqvi Syed M. Naqvi Shiao‐Pei S. Weathers Barbara J. O'Brien John F. deGroot Eduardo Bruera
author_sort	Rebecca A. Harrison
title	Aggressiveness of care at end of life in patients with high‐grade glioma
title_short	Aggressiveness of care at end of life in patients with high‐grade glioma
title_full	Aggressiveness of care at end of life in patients with high‐grade glioma
title_fullStr	Aggressiveness of care at end of life in patients with high‐grade glioma
title_full_unstemmed	Aggressiveness of care at end of life in patients with high‐grade glioma
title_sort	aggressiveness of care at end of life in patients with high‐grade glioma
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/e046fcbf01be4ef9ad2c508cd4b8d1c2
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Aggressiveness of care at end of life in patients with high‐grade glioma

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