The End-of-Life Hospital Setting in Patients with Glioblastoma

Oberndorfer, Stefan; Lindeck‐Pozza, Elisabeth; Lahrmann, Heinz; Struhal, W.; Hitzenberger, Peter; Grisold, Wolfgang

doi:10.1089/jpm.2007.0137

Cited by 87 publications

(57 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As a consequence of difficulties with managing acute symptoms at home, particularly seizures, admission to a hospital may be inevitable, which corresponds with previous reports on HGG patients [35,36]. Apart from impacting health care budgets, transitions in the EOL phase might affect a patient's personal dignity [17,37].…”

Section: Discussionsupporting

confidence: 70%

End of life care in high-grade glioma patients in three European countries: a comparative study

et al. 2014

View full text Add to dashboard Cite

Exploring cross-national differences is useful to evaluate whether different patterns of end of life (EOL) care meet patient's specific needs. This study aimed to (1) compare EOL care processes for high-grade glioma (HGG) patients in three European countries, (2) explore differences in perceived quality of care (QOC), and (3) identify aspects of good QOC in the EOL phase. We analyzed 207 questionnaires from relatives of deceased HGG patients, using a similar retrospective study design in three countries [The Netherlands (n = 83), Austria (n = 72) and the UK (n = 52)], and examined four subthemes: (1) organization of EOL care, (2) treatment preferences, (3) experiences with EOL care, (4) perceived QOC. Three months before death 75 % of patients were at home. In all countries, on average, 50 % were transferred to a hospital at least once and received effective symptom treatment during the last 3 months. In The Netherlands, Austria and UK, respectively, patients most often died at home (60 %), in a hospital (41 %) or hospice (41 %) (p < 0.001). Advance directives were present in 46 % of Dutch, 36 % of British and 6 % of Austrian patients (p < 0.001). Fifty-three percent of patients experienced good QOC, irrespective of country. Dying at the preferred place, satisfaction with information provided and effective symptom treatment were independently associated with good QOC. There are various cross-national differences in organization and experiences with EOL care for HGG, but patient's perceived QOC is similar in the three countries. As symptom treatment was considered effective in only half of HGG patients, and independently predicted good QOC, this particularly needs further improvement in all countries.

show abstract

Section: Discussionsupporting

confidence: 70%

End of life care in high-grade glioma patients in three European countries: a comparative study

et al. 2014

View full text Add to dashboard Cite

show abstract

“…As such, timely involvement of the patient in treatment decisions (including supportive measures ahead) is of paramount importance. Two systematic reviews of studies addressing the EOL phase, in high-grade gliomas, showed a high burden of symptoms, namely reduced consciousness (44-90%), dysphagia (10-85%), headache (36-62%), seizures (10-56%), focal neurological deficits (>50%), cognitive disturbances (>30%), confusion (15-51%), and poor communication ( 64-90%) (227,(231)(232)(233)(234)(235)(236).…”

Section: Supportive Carementioning

confidence: 99%

Current Standards of Care in Glioblastoma Therapy

et al. 2017

View full text Add to dashboard Cite

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Regardless of ideal multidisciplinary treatment, including maximal surgical resection, followed by radiotherapy plus concomitant and maintenance temozolomide (TMZ), almost all patients experience tumor progression with nearly universal mortality and a median survival of less than 15 months. The addition of bevacizumab to standard treatment with TMZ revealed no increase in overall survival (OS) but improved progression-free survival (PFS). In newly diagnosed GBM, methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter has been shown to predict response to alkylating agents, as well asgnosis. Therefore, MGMT promoter status may have a crucial role in the choice of single modality treatment in fragile elderly population. No standard of care is established in recurrent or progressive GBM. Treatment alternatives may include supportive care, surgery, re-irradiation, systemic therapies, and combined modality therapy. Despite numerous clinical trials, the identification of effective therapies is complex because of the lack of appropriate control arms, selection bias, small sample sizes, and disease heterogeneity. Tumor-treating fields plus TMZ represent a major advance in the field of GBM therapy, and should be Standards of Care in Glioblastoma Therapy 198 considered for patients with newly diagnosed GBM with no contraindications. As a disease with such a poor prognosis, treatment of GBM should go beyond improving survival and aim at preserving and even improving the quality of life of both the patient and the caregiver.

show abstract

“…14,15 Recent papers have reported that BT patients at the end of life present a high incidence of distressing symptoms that may impact their quality of life during the process of dying. 16,17 In order to allow the patient to experience a peaceful death, specific palliative interventions are necessary to control pain, confusion, agitation, delirium, or seizures. 18 In the large population of BT patients assisted until death by our neuro-oncological palliative home-care team since 2000, we have observed a high incidence of distressing symptoms impacting their quality of life during the last stage of disease and the process of dying.…”

Section: End Of Life Issues/treatment Decisionsmentioning

confidence: 99%

“…20 The majority of patients in their last month of life had difficulty taking oral medications due to dysphagia, disturbances in consciousness or both, which makes the use of the more commonly utilized oral antiepileptic drugs problematic at the end of life. 16,17 Thus, the anticonvulsant treatment in this stage of disease needs to be optimized, and oral treatment has to be adapted to find the optimal route for administering the drugs (intramuscular, rectal, transdermal, or subcutaneous).…”

Section: Seizuresmentioning

confidence: 99%