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Published on: January 19, 2024
Causes of Death and End-of-Life Care in Patients With Intracranial High-Grade Gliomas: A Retrospective Observational
Marissa Barbaro1, Craig D Blinderman1, Fabio M Iwamoto1
1From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY.
Insights
In patients with intracranial gliomas, clinical tumor progression was the most frequent cause of death. Most patients received comfort care, but 13.2% underwent resuscitation, highlighting the need for better end-of-life care discussions.
Area of Science:
- Neuro-oncology
- Palliative Care
- Medical Ethics
Background:
- Intracranial gliomas are aggressive brain tumors with significant end-of-life care challenges.
- Understanding end-of-life patterns is crucial for improving patient and caregiver support.
Purpose of the Study:
- To analyze the patterns of care and circumstances surrounding death in patients with intracranial gliomas.
- To identify common causes of death, locations of death, and the use of comfort measures and resuscitation.
Main Methods:
- Retrospective analysis of 152 patients with intracranial high-grade gliomas who died between January 2014 and February 2019.
- Data collected included cause of death, place of death, and interventions such as comfort measures and resuscitation.
Main Results:
- Clinical tumor progression (77.0%) was the leading cause of death, followed by infection (12.5%).
- Hospice or comfort measures were used in 94.7% of patients; 48.0% died at home with hospice.
- Resuscitative efforts were performed in 13.2% of patients.
Conclusions:
- Clinical progression and infection are primary drivers of mortality in glioma patients.
- While most patients receive comfort care, a notable percentage experience resuscitation, indicating a need for improved communication and planning.
- Enhanced understanding of end-of-life trajectories can facilitate better physician-patient discussions and informed care planning.
Background And Objectives:
To understand patterns of care and circumstances surrounding end of life in patients with intracranial gliomas.
Methods:
We retrospectively analyzed end-of-life circumstances in patients with intracranial high-grade gliomas at Columbia University Irving Medical Center who died from January 2014 to February 2019, including cause of death, location of death, and implementation of comfort measures and resuscitative efforts.
Results:
There were 152 patients (95 men, 57 women; median age at death 61.5 years, range 24-87 years) who died from January 2014 to February 2019 with adequate data surrounding end-of-life circumstances. Clinical tumor progression (n = 117, 77.0%) was the most common cause of death, with all patients transitioned to comfort measures. Other causes included, but were not limited to, infection (19, 12.5%); intratumoral hemorrhage (5, 3.3%); seizures (8, 5.3%); cerebral edema (4, 2.6%); pulmonary embolism (4, 2.6%); autonomic failure (2, 1.3%); and hemorrhagic shock (2, 1.3%). Multiple mortal events were identified in 10 (8.5%). Seventy-three patients (48.0%) died at home with hospice. Other locations were inpatient hospice (40, 26.3%); acute care hospital (34, 22.4%), including 27 (17.8%) with and 7 (4.6%) without comfort measures; skilled nursing facility (4, 3.3%), including 3 (2.0%) with and 1 (0.7%) without comfort measures; or religious facility (1, 0.7%) with comfort measures. Acute cardiac or pulmonary resuscitation was performed in 20 patients (13.2%).
Discussion:
Clinical tumor progression was the most common (77.0%) cause of death, followed by infection (12.5%). Hospice or comfort measures were ultimately implemented in 94.7% of patients, although resuscitation was performed in 13.2%. Improved understanding of circumstances surrounding death, frequency of use of hospice services, and frequency of resuscitative efforts in patients with gliomas may allow physicians to more accurately discuss end-of-life expectations with patients and caregivers, facilitating informed care planning.
