Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors

Dover, Laura; Dulaney, Caleb; Williams, Courtney; Fiveash, John B.; Jackson, Bradford E.; Warren, Paula; Kvale, Elizabeth; Boggs, Drexell Hunter; Rocque, Gabrielle Betty

doi:10.1093/neuonc/nox220

Cited by 21 publications

(12 citation statements)

References 48 publications

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“…Furthermore, the introduction of novel molecular treatment modalities such as targeted therapies and immune-checkpoint inhibitors [ 14 ] have rapidly changed treatment concepts for elderly patients with BM. Thus, patients who would have been previously classified as patients with poor prognosis because of the presence of multiple metastases or advanced age [ 15 , 16 , 17 ] may also benefit from these advances in local and systemic therapy. From a neurosurgical point of view, advanced age is associated with higher complication rates after surgical interventions because of age-associated co-morbidities [ 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment

et al. 2021

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In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups (p = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 vs. B: 8.12 months; p = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival (p = 0.00001). However, elderly patients less frequently received systemic treatment (p = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score (p = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival.

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Section: Introductionmentioning

confidence: 99%

Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment

et al. 2021

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“…The utilization of these services has shown to have numerous benefits, both for patients and for caregivers, although it has been documented that they are underused. In two retrospective cohort studies, late hospice referrals (within 7 days or sooner before death) were noted to occur 22-24% of the time in patients with primary malignant brain tumors [77,78]. Patients with later referrals were more debilitated and not able to achieve maximal benefit from hospice services.…”

Section: Hospicementioning

confidence: 99%

“…Risk factors that were associated with late referrals included male gender, lower socioeconomic status, and lack of a healthcare proxy [77]. Medicare expenditures were examined in older adults, and hospice utilization led to a mean reduction in approximately $12,000 in healthcare costs [78].…”

Section: Hospicementioning

confidence: 99%

Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review

Thakkar

Greenwald²,

Patel

2020

Brain Sciences

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Rehabilitative measures have been shown to benefit patients with primary brain tumors (PBT). To provide a high quality of care, clinicians should be aware of common challenges in this population including a variety of medical complications, symptoms, and impairments, such as headaches, seizures, cognitive deficits, fatigue, and mood changes. By taking communication and family training into consideration, clinicians can provide integrated and patient-centered care to this population. This article looks to review the current literature in outpatient and inpatient rehabilitation options for adult patients with PBTs as well as explore the role of the interdisciplinary team in providing survivorship care.

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“…Of those 63%, 11% were enrolled within 3 days of death, and 22% were enrolled within 7 days of death; the median time on hospice was 21 days. In general, patients with malignant brain tumors are referred to hospice less frequently and later in their disease course than other solid tumor patients, and late enrollees tend to have more severe neurologic debilitation than patients referred earlier, suggesting that they do not derive maximal benefit from the service [ 57 , 58 ]. Earlier incorporation of palliative care principles, such as advance care planning, may help identify the most appropriate time for hospice referral on an individual basis.…”

Section: Approachmentioning

confidence: 99%

Palliative Care in High-Grade Glioma: A Review

et al. 2020

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High-grade glioma (HGG) is characterized by debilitating neurologic symptoms and poor prognosis. Some of the suffering this disease engenders may be ameliorated through palliative care, which improves quality of life for seriously ill patients by optimizing symptom management and psychosocial support, which can be delivered concurrently with cancer-directed treatments. In this article, we review palliative care needs associated with HGG and identify opportunities for primary and specialty palliative care interventions. Patients with HGG and their caregivers experience high levels of distress due to physical, emotional, and cognitive symptoms that negatively impact quality of life and functional independence, all in the context of limited life expectancy. However, patients typically have limited contact with specialty palliative care until the end of life, and there is no established model for ensuring their palliative care needs are met throughout the disease course. We identify low rates of advance care planning, misconceptions about palliative care being synonymous with end-of-life care, and the unique neurologic needs of this patient population as some of the potential barriers to increased palliative interventions. Further research is needed to define the optimal roles of neuro-oncologists and palliative care specialists in the management of this illness and to establish appropriate timing and models for palliative care delivery.

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Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors

Abstract: Receiving late or no hospice care was common among older patients with malignant brain tumors and was significantly associated with increased total Medicare expenditures for patients with PMBT.

Cited by 21 publications

References 48 publications

Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment

Brain Metastases in Elderly Patients—The Role of Surgery in the Context of Systemic Treatment

Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review

Palliative Care in High-Grade Glioma: A Review

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