Home care for brain tumor patients

Pace, Andrea; Villani, Veronica; Pasquale, Antonella Di; Benincasa, Dario; Guariglia, Lara; Ieraci, Sonia; Focarelli, Silvia; Carapella, Carmine Maria; Pompili, Alfredo

doi:10.1093/nop/npt003

Cited by 26 publications

(59 citation statements)

References 24 publications

(29 reference statements)

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“…Although our data are only hypothesis-generating, during the CRT phase, nearly half the hospitalizations we observed were due to weakness, seizures, or VTE, suggesting that targeted efforts may be required to reduce morbidity and inpatient admission in this time period. Since hospitalization for weakness encompassed related issues of limited mobility and failure to thrive, earlier or more frequent outpatient physical therapy and mobility re-assessment [28,29], and stricter attention to each patient's corticosteroid needs [30], may be helpful in reducing admissions. While many patients may require physical therapy at a rehabilitation center, they typically must first be admitted to a hospital for three nights in order for Medicare to cover their rehabilitation or skilled nursing facility stay [31], which may increase hospitalizations that may otherwise be unnecessary.…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

et al. 2015

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Despite a high symptom burden, little is known about the incidence or predictors of hospitalization among glioblastoma patients, including risks during chemoradiation (CRT). We studied 196 consecutive newly diagnosed glioblastoma patients treated at our institution from 2006-2010. Toxicity data were reviewed during and after the CRT phase, defined as the period between diagnosis and 6 weeks after radiotherapy completion. Logistic regression and proportional hazards modeling identified predictors of hospitalization and overall survival (OS). Median age was 59 years (range, 23-90) and 83 % had Karnofsky performance status (KPS) score ≥ 70. Twenty-six percent of patients underwent gross total resection, 77 % received ≥ 59.4 Gy of radiotherapy, and 89 % received concurrent temozolomide. Median OS was 15.6 months (IQR, 8.5-26.8 months). Forty-three percent of patients were hospitalized during the CRT phase; OS was 10.7 vs. 17.8 months for patients who were vs. were not hospitalized, respectively (P < .001). Nearly half of the hospitalizations were due to generalized weakness (17 % of hospitalizations), seizures (16 %), or venous thromboembolism (13 %). On multivariate analysis, age (odds ratio [OR], 1.03; 95 % CI, 1.002-1.060; P = .034) and KPS (OR, 0.95; 95 % CI, 0.93-0.97; P < .001) were associated with risk of hospitalization. Hospitalization during the CRT phase was associated with decreased OS (adjusted hazard ratio, 1.47; 95 % CI, 1.01-2.13; P = .043), after adjustment for known prognostic factors. Hospitalization during the CRT phase is common among glioblastoma patients in the temozolomide era and is associated with shorter overall survival.

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Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

et al. 2015

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“…Most studies in glioma are retrospective cohort studies studying patients with neurological deficits that warrant specialised inpatient neuro-rehabilitation 40 , and only a few studies examine outpatient rehabilitation. 41 Some studies match controls with other conditions, e.g. stroke or traumatic brain injury.…”

Section: Neuro-rehabilitationmentioning

confidence: 99%

“…Physical and cognitive dysfunctions occurring in brain tumour patients, with changes in behaviour and impairment in communication, may affect dignity and expose patients and relatives to stress 71,74 , and can influence the organization of care such as place of care, place of death and decisions about EOL. A significant correlation has been shown between dying with dignity and the absence of communication deficits, good communication with the physicians, fewer transitions between health care settings, and dying at the preferred place of death.…”

Section: Organisation Of Care In the Eol Phasementioning

confidence: 99%

European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma

Pace¹,

Dirven

Koekkoek

et al. 2017

The Lancet Oncology

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225

184

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Patients with glioma present with complex palliative care needs throughout their disease trajectory. The life-limiting nature of gliomas and the presence of specific symptoms related to neurological deterioration necessitate an appropriate and early palliative care approach. The multidisciplinary palliative care task force of the European Association of Neuro-Oncology did a systematic review of the available scientific literature to formulate the best possible evidence-based recommendations for the palliative care of adult patients with glioma, with the aim to reduce symptom burden and improve the quality of life of patients and their caregivers, particularly in the end-of-life phase. When recommendations could not be made because of the scarcity of evidence, the task force either used evidence from studies of patients with systemic cancer or formulated expert opinion. Areas of palliative care that currently lack evidence and thus deserve attention for further research are fatigue, disorders of behaviour and mood, interventions for the needs of caregivers, and timing of advance care planning.

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“…Studies concerning the palliative management of neurosurgical patients are limited [3][4][18][19][20] , and few focus on and examine the effects of at-home palliative care 1,21 . Although patients have expressed general satisfaction with neuro-palliative care, no study has qualitatively evaluated the emotional effects of at-home compared with inpatient hospice palliative care from the patient perspective, and how the patient experience relates to quality of life.…”

Section: Introductionmentioning

confidence: 99%

The Views of Patients with Brain Cancer about Palliative Care: A Qualitative Study

et al. 2017

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Home care for brain tumor patients

Abstract: Background. Brain tumor patients are quite different from other populations of cancer patients due to the complexity of supportive care needs, the trajectory of disease, the very short life expectancy, and resulting need for a specific palliative approach.

Cited by 26 publications

References 24 publications

Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma

The Views of Patients with Brain Cancer about Palliative Care: A Qualitative Study

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