BACKGROUND Glioblastoma is a highly aggressive grade IV tumor of the brain. Standard of care is maximal safe resection followed by radiation therapy and chemotherapy. Despite optimal management, majority recur, and the median survival is 2-3 years. Hospice is a philosophy of care to alleviate end-of-life suffering, and it can also relieve caregiver fatigue. METHODS This is a retrospective chart review in a tertiary care center. IRB approval was obtained from the Office for the Protection of Research Subjects. ICD-10 code for malignant gliomas C71.9 was used to query EMR at UIC from 2015-2020. Patients with primary glioblastoma that had their entire neuro-oncologic care at UIC were included in the data analysis. Patient’s age < 18 years, unknown date of death, or those who transitioned to a different facility were excluded. Data included were demographic (including marital status as a proxy for social support), insurance, ethnicity, tumor characteristics, and treatments provided. End-of life quality measure assessed were (1)no chemotherapy < 2w, (2)hospice status < 7 days, (3)no hospital admission > 30 days (4)no ICU admission < 14 days. RESULTS 48 patients with primary glioblastoma were identified and out of those, a total of 35 patients received entirety of neurooncological care at our center. Date of death was available for 13 patients. 9 patients had been referred to hospice and 4 were not. Demographic variables were similar except social support – patients referred to hospice were more likely to be married. End-of-life quality measures were met in all patients in hospice group (9/9) but only in half of those not referred to hospice (2/4). DISCUSSION Social support has an impact on enrollment of hospice care. Including goals of care discussion earlier in the treatment would require a multi-disciplinary team with additional involvement of supportive care, nurses, and social workers.
BACKGROUND/OBJECTIVES Supportive Care and Social Work services are underutilized in Neurooncology. ASCO Quality Oncology Program Initiative (QOPI) includes emotional assessment by second and advance care planning (ACP) by third oncologic visit in solid malignancies. We looked (1) reason, location, and the duration from diagnosis for the involvement of supportive care teams and (2) what are the determining factors for advanced care planning in glioblastoma. METHODS After obtaining an IRB approval for the study, we performed a retrospective chart review of glioblastoma patients seen at University of Illinois Chicago 2015-2020 using the ICD Code C71.9 for malignant gliomas. Patients who had a pathologic diagnosis of glioblastoma, age > 18 years, and had their entire neurooncologic care at UIC were included in the study. Demographic features, socioeconomic determinants, tumor characteristics, and treatment history were noted. Supportive Care Teams and Social Work notes were reviewed. RESULTS Out of the total 403 patients, there were 78 glioblastoma patients. A total 33 met the inclusion criteria. 10 out of 33 had been seen by the supportive care team. Patients in both groups were equally matched for demographics, socioeconomic determinants, and tumor characteristics. ACP were significantly better documented in the supportive care group (p = 0.035). Supportive Care teams were consulted much later after the disease diagnosis, usually in the inpatient setting mostly consulted for goals of care discussion and hospice enrollment. There was a significant positive correlation between the involvement of Supportive Care team and Social Work. DISCUSSION A multidisciplinary clinic including an inbuilt palliative and social work teams can improve the Quality of Life (QoL) in glioblastoma patients and their caregivers. ICD code 99497 for a dedicated ACP discussion by the neurooncologist can be used. An ongoing phase III RCT EPCOG aims to assess (QoL) in patients with glioblastoma receiving early palliative intervention.
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