A retrospective chart review to identify the involvement of palliative care with glioblastoma multiforme patients

Júlia Drummond de Camargo, Fernanda Avallone Machado Laureano de Souza, Ivy de Carvalho Ramalho de Oliveira, Jéssica Anastacia Silva Barbosa

Abstract


Background: Glioblastoma Multiforme is a deadly brain cancer that is very challenging for patients and their families. It is associated with rapid progression, cognitive decline, and a low survival rate. 

Objective: To determine whether deceased Glioblastoma Multiforme patients had received follow-up service from the palliative care team before their death, whether invasive measures had been reduced, and whether the last antineoplastic treatment was given within 14–30 days before death. 

Method: A retrospective study utilizing chart data from January 2020 to March 2022 from an institutional project. Data were gathered to reflect selected indicators of quality of care for palliative care patients.

Results: Of the 30 hospitalized patients with Glioblastoma Multiforme who had died while in hospital, 50% had received support from the palliative care team. Two patients (6.7%) had undergone antineoplastic treatment in the last 14 days of life and 13 (43.3%) had an order limiting invasive measures defined in the last two weeks of life.

Conclusion: In half of the patients monitored by a palliative care team, antineoplastic treatment and limitation of invasive measures occurred in the last 14 days of life. This may be associated with increased suffering of patients, family members, and professionals. Discussions about end-of-life care-related choices and goals of care need to be respected.

Keywords: oncology, palliative care, Glioblastoma Multiforme, end-of-life care


Full Text:

PDF

References


ASCO Institute for Quality. Quality Oncology Practice Initiative. http://www.instituteforquality.org/qopi/measures.

Boele, F. W., Butler, S., Nicklin, E., Bulbeck, H., Pointon, L., Short, S. C., & Murray, L. (2023). Communication in the context of glioblastoma treatment: A qualitative study of what matters most to patients, caregivers and health care professionals. Palliative Medicine, 2692163231152525. Advance online publication. https://doi.org/10.1177/02692163231152525

Brom, L., Onwuteaka-Philipsen, B. D., Widdershoven, G. A., & Pasman, H. R. (2016). Mechanisms that contribute to the tendency to continue chemotherapy in patients with advanced cancer. Qualitative observations in the clinical setting. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 24(3), 1317–1325. https://doi.org/10.1007/s00520-015-2910-7

Campbell, C. S., Hare, J., & Matthews, P. (1995). Conflicts of conscience. Hospice and assisted suicide. The Hastings Center Report, 25(3), 36–43.

Catt, S., Chalmers, A., & Fallowfield, L. (2008). Psychosocial and supportive-care needs in high-grade glioma. The Lancet. Oncology, 9(9), 884–891. https://doi.org/10.1016/S1470-2045(08)70230-4

Crooms, R. C., Goldstein, N. E., Diamond, E. L., & Vickrey, B. G. (2020). Palliative Care in High-Grade Glioma: A Review. Brain Sciences, 10(10), 723. https://doi.org/10.3390/brainsci10100723

Davis, M. E. (2016). Glioblastoma: Overview of disease and treatment. Clinical Journal of Oncology Nursing, 20(5 Suppl), S2–S8. https://doi.org/10.1188/16.CJON.S1.2-8

Diamond, E. L., Russell, D., Kryza-Lacombe, M., Bowles, K. H., Applebaum, A. J., Dennis, J., DeAngelis, L. M., & Prigerson, H. G. (2016). Rates and risks for late referral to hospice in patients with primary malignant brain tumors. Neuro-oncology, 18(1), 78–86. https://doi.org/10.1093/neuonc/nov156

Engelhardt, B. (2022). Palliative care: Patient’s autonomy in the end-of-life situation. Memo, 15, 76–78. https://doi.org/10.1007/s12254-021-00783-5

Fadul, N., Elsayem, A., Palmer, J. L., Del Fabbro, E., Swint, K., Li, Z., Poulter, V., & Bruera, E. (2009). Supportive versus palliative care: What’s in a name?: A survey of medical oncologists and midlevel providers at a comprehensive cancer center. Cancer, 115(9), 2013–2021. https://doi.org/10.1002/cncr.24206

Floriani, C. A., & Schramm, F. R. (2008). Cuidados paliativos: interfaces, conflitos e necessidades. Ciência & Saúde Coletiva, 13(Sup 2), 2123–2132. https://doi.org/10.1590/S1413-81232008000900017

Ford, E., Catt, S., Chalmers, A., & Fallowfield, L. (2012). Systematic review of supportive care needs in patients with primary malignant brain tumors. Neuro-oncology, 14(4), 392–404. https://doi.org/10.1093/neuonc/nor229

Forte, D. N., Kawai, F., & Cohen, C. (2018). A bioethical framework to guide the decision-making process in the care of seriously ill patients. BMC Medical Ethics, 19(1), 1–8.

Giammalva, G. R., Iacopino, D. G., Azzarello, G., Gaggiotti, C., Graziano, F., Gulì, C., Pino, M. A., & Maugeri, R. (2018). End-of-life care in high-grade glioma patients. The palliative and supportive perspective. Brain Sciences, 8(7), 125. https://doi.org/10.3390/brainsci8070125

Golla, H., Nettekoven, C., Bausewein, C., Tonn, J. C., Thon, N., Feddersen, B., Schnell, O., Böhlke, C., Becker, G., Rolke, R., Clusmann, H., Herrlinger, U., Radbruch, L., Vatter, H., Güresir, E., Stock, S., Müller, D., Civello, D., Papachristou, I., Hellmich, M., … EPCOG study group (2020). Effect of early palliative care for patients with glioblastoma (EPCOG): A randomised phase III clinical trial protocol. BMJ Open, 10(1), e034378. https://doi.org/10.1136/bmjopen-2019-034378

Hemminger, L. E., Pittman, C. A., Korones, D. N., Serventi, J. N., Ladwig, S., Holloway, R. G., & Mohile, N. A. (2017). Palliative and end-of-life care in glioblastoma: Defining and measuring opportunities to improve care. Neuro-oncology Practice, 4(3), 182–188. https://doi.org/10.1093/nop/npw022

Hui, D., & Bruera, E. (2015). Models of integration of oncology and palliative care. Ann Palliat Med, 4(3), 89–98.

Hui, D., Park, M., Liu, D., Reddy, A., Dalal, S., & Bruera, E. (2015). Attitudes and beliefs toward supportive and palliative care referral among hematologic and solid tumor oncology specialists. The oncologist, 20(11), 1326–1332. https://doi.org/10.1634/theoncologist.2015-0240

Kim, J. Y., Peters, K. B., Herndon, J. E., 2nd, & Affronti, M. L. (2020). Utilizing a palliative care screening tool in patients with glioblastoma. Journal of the Advanced Practitioner in Oncology, 11(7), 684–692. https://doi.org/10.6004/jadpro.2020.11.7.3

La Torre, D., Maugeri, R., Angileri, F. F., Pezzino, G., Conti, A., Cardali, S. M., Calisto, A., Sciarrone, G., Misefari, A., Germanò, A., & Tomasello, F. (2009). Human leukocyte antigen frequency in human high-grade gliomas: A case-control study in Sicily. Neurosurgery, 64(6), 1082–1089. https://doi.org/10.1227/01.NEU.0000345946.35786.92

Mack, J. W., Weeks, J. C., Wright, A. A., Block, S. D., & Prigerson, H. G. (2010). End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 28(7), 1203–1208. https://doi.org/10.1200/JCO.2009.25.4672

Maugeri, R., Schiera, G., Di Liegro, C. M., Fricano, A., Iacopino, D. G., & Di Liegro, I. (2016). Aquaporins and brain tumors. International Journal of Molecular Sciences, 17(7), 1029. https://doi.org/10.3390/ijms17071029

McConigley, R., Halkett, G., Lobb, E., & Nowak, A. (2010). Caring for someone with high-grade glioma: A time of rapid change for caregivers. Palliative medicine, 24(5), 473–479. https://doi.org/10.1177/0269216309360118

Menezes, M. B. D., Selli, L., & Alves, J. D. S. (2009). Dysthanasia: Nursing professionals’ perception. Revista Latino-Americana de Enfermagem, 17, 443–448.

Miranda, A., Blanco-Prieto, M., Sousa, J., Pais, A., & Vitorino, C. (2017). Breaching barriers in glioblastoma. Part I: Molecular pathways and novel treatment approaches. International Journal of Pharmaceutics, 531(1), 372–388. https://doi.org/10.1016/j.ijpharm.2017.07.056

Perrin, K. O., & Kazanowski, M. (2015). Overcoming barriers to palliative care consultation. Critical care nurse, 35(5), 44–52. https://doi.org/10.4037/ccn2015357

Philip, J., Collins, A., Brand, C., Gold, M., Moore, G., Sundararajan, V., … Lethborg, C. (2015). Health care professionals’ perspectives of living and dying with primary malignant glioma: Implications for a unique cancer trajectory. Palliative & Supportive Care, 13(6), 1519-1527. doi:10.1017/S1478951513000576

Philip, J., Collins, A., Brand, C., Sundararajan, V., Lethborg, C., Gold, M., Lau, R., Moore, G., & Murphy, M. (2018). A proposed framework of supportive and palliative care for people with high-grade glioma. Neuro-oncology, 20(3), 391–399. https://doi.org/10.1093/neuonc/nox140

Pompili, A., Telera, S., Villani, V., & Pace, A. (2014). Home palliative care and end of life issues in glioblastoma multiforme: Results and comments from a homogeneous cohort of patients. Neurosurgical Focus, 37(6), E5. https://doi.org/10.3171/2014.9.FOCUS14493

Pottash, M., McCamey, D., Groninger, H., Aulisi, E. F., & Chang, J. J. (2020). Palliative care consultation and effect on length of stay in a tertiary-level neurological intensive care unit. Palliative Medicine Reports, 1(1), 161–165. https://doi.org/10.1089/pmr.2020.0051

Schubart, J. R., Kinzie, M. B., & Farace, E. (2008). Caring for the brain tumor patient: Family caregiver burden and unmet needs. Neuro-oncology, 10(1), 61–72. https://doi.org/10.1215/15228517-2007-040

Silva, K. C. O., Quintana, A. M., & Nietsche, E. A. (2012). Obstinação terapêutica em Unidade de Terapia Intensiva: perspectiva de médicos e enfermeiros. Escola Anna Nery, 16(Esc. Anna Nery, 2012 16(4)), 697–703. https://doi.org/10.1590/S1414-81452012000400008

Stupp, R., Mason, W. P., van den Bent, M. J., Weller, M., Fisher, B., Taphoorn, M. J., Belanger, K., Brandes, A. A., Marosi, C., Bogdahn, U., Curschmann, J., Janzer, R. C., Ludwin, S. K., Gorlia, T., Allgeier, A., Lacombe, D., Cairncross, J. G., Eisenhauer, E., Mirimanoff, R. O., European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups, … National Cancer Institute of Canada Clinical Trials Group (2005). Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. The New England Journal of Medicine, 352(10), 987–996. https://doi.org/10.1056/NEJMoa043330

Tan, A. C., Ashley, D. M., López, G. Y., Malinzak, M., Friedman, H. S., & Khasraw, M. (2020). Management of glioblastoma: State of the art and future directions. CA: A cancer journal for clinicians, 70(4), 299–312. https://doi.org/10.3322/caac.21613

Thakkar, J. P., Dolecek, T. A., Horbinski, C., Ostrom, Q. T., Lightner, D. D., Barnholtz-Sloan, J. S., & Villano, J. L. (2014). Epidemiologic and molecular prognostic review of glioblastoma. Cancer epidemiology, biomarkers & prevention: A publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 23(10), 1985–1996. https://doi.org/10.1158/1055-9965.EPI-14-0275

Thier, K., Calabek, B., Tinchon, A., Grisold, W., & Oberndorfer, S. (2016). The last 10 days of patients with glioblastoma: Assessment of clinical signs and symptoms as well as treatment. The American Journal of Hospice & Palliative Care, 33(10), 985–988. https://doi.org/10.1177/1049909115609295

Tran, L. N., Back, A. L., & Creutzfeldt, C. J. (2016). Palliative care consultations in the neuro-ICU: A qualitative study. Neurocritical care, 25(2), 266–272. https://doi.org/10.1007/s12028-016-0283-5

Walbert, T., Puduvalli, V. K., Taphoorn, M. J. B., Taylor, A. R., & Jalali, R. (2015). International patterns of palliative care in neuro-oncology: A survey of physician members of the Asian Society for Neuro-Oncology, the European Association of Neuro-Oncology, and the Society for Neuro-Oncology. Neuro-oncology practice, 2(2), 62–69. https://doi.org/10.1093/nop/npu037

Wu, A., Ruiz Colón, G., Aslakson, R., Pollom, E., & Patel, C. B. (2021). Palliative care service utilization and advance care planning for adult glioblastoma patients: A systematic review. Cancers, 13(12), 2867. https://doi.org/10.3390/cancers13122867

Zimmermann, C., Swami, N., Krzyzanowska, M., Leighl, N., Rydall, A., Rodin, G., & Hannon, B. (2016). Perceptions of palliative care among patients with advanced cancer and their caregivers. Canadian Medical Association Journal, 188(10), E217–E227. https://doi.org710.1503/cmaj.151171


Refbacks

  • There are currently no refbacks.