End-of-Life Care in High-Grade Glioma Patients. The Palliative and Supportive Perspective

Abstract

High-grade gliomas (HGGs) are the most frequently diagnosed primary brain tumors. Even though it has been demonstrated that combined surgical therapy, chemotherapy, and radiotherapy improve survival, HGGs still harbor a very poor prognosis and limited overall survival. Differently from other types of primary neoplasm, HGG manifests also as a neurological disease. According to this, palliative care of HGG patients represents a peculiar challenge for healthcare providers and caregivers since it has to be directed to both general and neurological cancer symptoms. In this way, the end-of-life (EOL) phase of HGG patients appears to be like a journey through medical issues, progressive neurological deterioration, and psychological, social, and affective concerns. EOL is intended as the time prior to death when symptoms increase and antitumoral therapy is no longer effective. In this phase, palliative care is intended as an integrated support aimed to reduce the symptoms burden and improve the Quality Of Life (QOL). Palliative care is represented by medical, physical, psychological, spiritual, and social interventions which are primarily aimed to sustain patients’ functions during the disease time, while maintaining an acceptable quality of life and ensuring a dignified death. Since HGGs represent also a family concern, due to the profound emotional and relational issues that the progression of the disease poses, palliative care may also relieve the distress of the caregivers and increase the satisfaction of patients’ relatives. We present the results of a literature review addressed to enlighten and classify the best medical, psychological, rehabilitative, and social interventions that are addressed both to patients and to their caregivers, which are currently adopted as palliative care during the EOL phase of HGG patients in order to orientate the best medical practice in HGG management.

Health-related quality of life and distress in elderly vs. younger patients with high-grade glioma—results of a multicenter study

“…On the other hand, older patients may be more satisfied with their life lived thus far and less anxious about life-time lost due to the disease. Furthermore, elderly people could hesitate to allow depressive thoughts and try to present themselves strong, compliant, and positive in order to preserve their strength but also the support of the doctor as long as advanced care planning is not early enough provided [31,32].…”

A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme

“…Better understanding of the rehabilitation potential of GBM patients throughout the disease trajectory is critical, as patients with progressive disease experience an increase in cognitive deficits related to tumor growth and treatment side effects from radiation therapy, systemic treatment, and commonly used medications such as steroids and antiepileptic medications. 17,30 With a growing symptom burden and continuing neurological deterioration, future studies may observe that at a certain stage of disease progression, patients may not be able to participate with therapy or make functional gains in the acute rehabilitation setting. These patients may better benefit from other settings such as skilled nursing facilities, long-term acute care hospitals, and hospices.…”

“…This population faces additional cognitive and physical impairments related to progressive neurological disease and treatment side effects from radiation therapy, chemotherapy, and medications commonly used in this population such as steroids and antiepileptic medications. 5,17,18 At this time, there is limited literature to guide physicians on whether patients with rGBM may benefit from a course of acute inpatient rehabilitation. As treatments for GBM continue to evolve and as survival improves, examining the functional outcomes of this population in the IRF setting will become essential.…”

Predictors of Death at Home Among Cancer Patients in Israel: A Population-based Study

“…In contrast to those suffering from hematologic malignancies, patients with brain tumors have the highest rates of death at home. Swallowing di culties combined with decreased consciousness are frequently seen among these patients during the end-of-life period [24]. These symptoms frequently appear a few weeks before death.…”