Temporal Trends in Palliative Care Integration for High-Grade Glioma: A Seven-Year Retrospective Cohort Study

PurposeHigh-grade gliomas (HGG) have a poor prognosis and high symptom burden, yet palliative care (PC) integration remains limited. We evaluated temporal changes in PC referral and assessment patterns at a Brazilian tertiary center and explored prognostic factors for survival.MethodsThis is a non-concurrent retrospective cohort of 117 adults with HGG who underwent surgery between 2017 and 2023. Primary outcomes included rates of PC referral and effective assessment, time to referral, and functional status (Karnofsky Performance Status, KPS) at referral. Secondary outcomes included overall survival (OS) and identification of prognostic factors using Cox regression analysis. Temporal trends were analyzed using the Cochran-Armitage test.ResultsPC referral increased from 21.1% (2017) to 73.7% (2023) (P < 0.001), and effective assessment increased from 21.1% to 47.4% (P = 0.048). Median Karnofsky Performance Status at referral improved over time (P = 0.011). In multivariate analysis, baseline clinical factors (older age and lower preoperative KPS) predicted earlier mortality; PC referral and effective assessment were not independently associated with survival after adjustment.ConclusionOver seven years, a significant increase in PC referrals and an improvement in functional status at the time of PC access were observed. Preoperative functional status was the main determinant of survival.