OP-4 Characteristics of primary brain tumour patients receiving end-of-life care in a quaternary cancer care hospital
Year: 2024
Type: conference-paper
Study design: Observational Study
Abstract: Background Patients with primary brain tumours experience challenging symptoms and benefit from timely specialist palliative care referral.1 Prognosis is poor, particularly for high grade gliomas.1 This study, the first of its kind to the author’s knowledge, aims to assess the clinical characteristics, reasons for and timing of referral, symptom burden, multidisciplinary interventions and end-of-life medication utilisation in patients with primary brain tumours referred to palliative care who received end-of-life care in a quaternary cancer care hospital. This study also aims to explore the psychosocial impacts of primary brain cancer on patients and their carers. Methods A retrospective review was conducted of patients with primary brain tumours referred to a palliative care service who died in a quaternary cancer care hospital between the period of March 2022 and May 2024 (at the time of submission). Data was collected from electronic medical records and paper medication charts with focus on the inpatient hospital admission where end-of-life care was provided. Descriptive statistics and thematic analysis were used to analyse preliminary clinical data. Results At the time of submission, 13 patients met the inclusion criteria. At initial diagnosis, 11 patients had glioblastoma multiforme, one patient had grade II astrocytoma (grade III on subsequent recurrences) and one patient had stage III anaplastic oligodendroglioma. All patients were male. Median age at the time of death was 57 (range 35–81). Mean survival from the time of diagnosis was 11 months (range 2–24) for the patients with glioblastoma multiforme, whilst the two patients with lower grade tumours had survival times of 150 and 251 months. The reasons prompting final hospital admission were multifactorial, with functional decline the most common (N=9). Patients were known to palliative care (either community or inpatient services) for a mean of six months (range 1 day–23 months) prior to death. Patients were usually referred to palliative care for management of physical symptoms (N=11). At the time of inpatient palliative care referral, the median patient Australia-modified Karnofsky Performance Status was 30 (range 20–40). Progressive drowsiness, functional decline and gait disturbance were noted in all patients. Other frequently reported symptoms were fatigue (N=11), delirium (N=8), agitation/restlessness (N=8), constipation (N=8), headache (N=7), nausea (N=5) and seizures (N=5). Regular opioids and benzodiazepines were used in all patients at the time of death. Levetiracetam was the most utilised anticonvulsant at end-of-life (N=9). All patients saw a physiotherapist during their admission. Rates of referral to other members of the interdisciplinary team varied. The most common theme in the psychosocial domain was a mismatch between escalating care requirements from progressive functional decline and capacity to meet these needs in the home environment. Conclusion Preliminary results highlight the high symptom burden and challenging neurological decline faced by patients with primary brain tumours. It emphasises the importance of early palliative care involvement in addition to multidisciplinary delivery of holistic support to patients and caregivers. Reference Giammalva GR, Iacopino DG, Azzarello G, et al. End-of-life care in high-grade glioma patients. The palliative and supportive perspective. Brain Sci. 2018 Jul;8(7):125.
Source: Oral Presentations
Authors: Amelia Denniss, Sarah Bishop Browne
Institution: Chris O’Brien Lifehouse
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402325379