Frequency and Predictors of Acute Hospitalization Before Death in Patients With Glioblastoma

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• 作者：Eli L. Diamond ; MD ; MPhil^a ; ^b ; ^c ; ^{diamone1@mskcc.org} ; Katherine S. Panageas ; DrPH^d ; Alexis Dallara ; MD^e ; Ariel Pollock ; BA^f ; Allison J. Applebaum ; PhD^g ; Alan C. Carver ; MD^a ; ^b ; Elena Pentsova ; MD^a ; Lisa M. DeAngelis ; MD^a ; Holly G. Prigerson ; PhD^c
• 关键词：Malignant brain tumor ; glioblastoma ; palliative care ; quality of life
• 刊名：Journal of Pain and Symptom Management
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：53
• 期：2
• 页码：257-264
• 全文大小：261 K
• 卷排序：53

文摘

Glioblastoma (GBM) is a devastating and incurable neuro-oncologic disease, and issues related to the end of life are almost invariably a matter of “when,” not a matter of “if.” Optimizing symptom management and quality of life in later stages of disease is of the utmost priority.ObjectivesTo examine the frequency of and factors associated with late acute hospital admission before death in patients with GBM.MethodsCase-control study comparing patients with GBM admitted to the hospital within one month of death to those without late hospital admission.ResultsOf 385 GBM patients followed to death at Memorial Sloan Kettering Cancer Center, 164 (42.6%) were admitted within a month of death, most frequently (140, or 85%) to manage neurologic decline. Of these, 56 (34%) had intensive care unit care during this admission and 22 (13%), 18 (11%), and 2 (1%) received mechanical ventilation, enteral feeding tubes, or cardiopulmonary resuscitation, respectively. In multivariable analysis, in-hospital chaplaincy consultation, and participation in a therapeutic clinical trial, both at any time in the GBM disease course, were significantly associated with late hospital admission.ConclusionsLate hospitalization is frequent in GBM and often involves intensive care unit care in the management of clinical events that are part of the GBM dying process. Patients with a tendency to use religious support and those enrolled in clinical trials may be at greater risk for late hospitalization. Dedicated prospective study is needed to determine predictors of late hospitalization and to examine the impact of late acute medical care on quality of life in GBM.