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Palliative care referral across the disease trajectory in high-grade glioma
Rita C Crooms1,2, Jennie W Taylor3, Nathalie Jette4,5
1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. caroline.crooms@mssm.edu.
Insights
A minority of high-grade glioma patients received palliative care consultation (PCC), often late in their disease course. Early PCC was associated with longer survival, highlighting the need to improve access to this crucial supportive care.
Area of Science:
- Neuro-oncology
- Palliative Care
- Health Services Research
Background:
- High-grade glioma (HGG) patients have significant palliative care needs.
- Palliative care consultation (PCC) can improve quality of life for cancer patients.
- Understanding PCC patterns in HGG is crucial for optimizing supportive care.
Purpose of the Study:
- To determine the occurrence and timing of PCC in adult HGG patients.
- To identify factors associated with receiving PCC.
- To examine the impact of PCC timing on survival.
Main Methods:
- Retrospective cohort study of 621 HGG patients (2011-2020).
- Analysis of PCC occurrence and timing by disease phase (diagnosis, initial, second-line, end-of-life).
- Multivariable logistic regression to identify factors associated with PCC.
Main Results:
- 21.58% of HGG patients received PCC, mostly during hospitalization.
- Nearly half (48.51%) of PCCs occurred during the end-of-life phase.
- Earlier PCC (before end-of-life) was linked to significantly longer survival (16.5 vs. 11 months).
Conclusions:
- PCC is underutilized in HGG patients, with late referrals being common.
- Early PCC is associated with improved survival, suggesting a need for timely integration.
- Barriers and facilitators to early PCC in HGG require further investigation.
Purpose:
Adults with high-grade glioma (HGG), WHO grade III or IV, have substantial palliative care needs. Our aim was to determine occurrence, timing, and factors associated with palliative care consultation (PCC) in HGG at one large academic institution.
Methods:
HGG patients receiving care between 08/1/2011 and 01/23/2020 were identified retrospectively from a multi-center healthcare system cancer registry. Patients were stratified by any PCC (yes/no), and timing of initial PCC by disease phase: diagnosis (before radiation), during initial treatment (first-line chemotherapy/radiation), second-line treatment(s), or end-of-life (after last chemotherapy).
Results:
Of 621 HGG patients, 134 (21.58%) received PCC with the vast majority occurring during hospital admission [111 (82.84%)]. Of the 134, 14 (10.45%) were referred during the diagnostic phase; 35 (26.12%) during initial treatment; 20 (14.93%) during second-line treatment; and 65 (48.51%) during end of life. In multivariable logistic regression, only higher Charlson Comorbidity Index was associated with greater odds of PCC [OR 1.3 (95% CI 1.2-1.4), p < 0.01]; but not age or histopathology. Patients who received PCC prior to end of life had longer survival from diagnosis than those referred during end of life [16.5 (8, 24) months vs. 11 (4, 17); p < 0.01].
Conclusion:
A minority of HGG patients ever received PCC, which primarily occurred in the inpatient setting, and nearly half during the end-of-life phase. Thus, only about one in ten patients in the entire cohort potentially received the benefits of earlier PCC despite earlier referral having an association with longer survival. Further studies should elucidate barriers and facilitators to early PCC in HGG.
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