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Palliative care referral across the disease trajectory in high-grade glioma

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Abstract

Purpose

Adults with high-grade glioma (HGG), WHO grade III or IV, have substantial palliative care needs. Our aim was to determine occurrence, timing, and factors associated with palliative care consultation (PCC) in HGG at one large academic institution.

Methods

HGG patients receiving care between 08/1/2011 and 01/23/2020 were identified retrospectively from a multi-center healthcare system cancer registry. Patients were stratified by any PCC (yes/no), and timing of initial PCC by disease phase: diagnosis (before radiation), during initial treatment (first-line chemotherapy/radiation), second-line treatment(s), or end-of-life (after last chemotherapy).

Results

Of 621 HGG patients, 134 (21.58%) received PCC with the vast majority occurring during hospital admission [111 (82.84%)]. Of the 134, 14 (10.45%) were referred during the diagnostic phase; 35 (26.12%) during initial treatment; 20 (14.93%) during second-line treatment; and 65 (48.51%) during end of life. In multivariable logistic regression, only higher Charlson Comorbidity Index was associated with greater odds of PCC [OR 1.3 (95% CI 1.2–1.4), p < 0.01]; but not age or histopathology. Patients who received PCC prior to end of life had longer survival from diagnosis than those referred during end of life [16.5 (8, 24) months vs. 11 (4, 17); p < 0.01].

Conclusion

A minority of HGG patients ever received PCC, which primarily occurred in the inpatient setting, and nearly half during the end-of-life phase. Thus, only about one in ten patients in the entire cohort potentially received the benefits of earlier PCC despite earlier referral having an association with longer survival. Further studies should elucidate barriers and facilitators to early PCC in HGG.

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Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to sensitivity and data user agreements of the Mount Sinai Data Warehouse and Mount Sinai Cancer Registry, but are available from the corresponding author on reasonable request and permission from those entities and the Institutional Review Board.

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Acknowledgements

This work was supported in part through the Mount Sinai Cancer Registry resources and staff expertise provided by The Tisch Cancer Center at Mount Sinai. Additional support was provided through the Mount Sinai Data Warehouse (MSDW) resources and staff expertise provided by Scientific Computing and Data at the Icahn School of Medicine at Mount Sinai.

Funding

This work was supported by the National Institute on Aging (AG074064-01). Additional support was provided by the Claude D. Pepper Older Americans Independence Center at the Icahn School of Medicine at Mount Sinai (5P30AG028741) and by the Mount Sinai Institute for Health Equity Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The investigators have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Rita C. Crooms, Nathalie Jette, Rachelle Morgenstern, Parul Agarwal & Barbara G. Vickrey

  2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Rita C. Crooms & Nathan E. Goldstein

  3. Departments of Neurology and Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA

    Jennie W. Taylor

  4. Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Nathalie Jette & Parul Agarwal

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RCC, RM, and PA. The first draft of the manuscript was written by RCC and RM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Rita C. Crooms.

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Crooms, R.C., Taylor, J.W., Jette, N. et al. Palliative care referral across the disease trajectory in high-grade glioma. J Neurooncol 163, 249–259 (2023). https://doi.org/10.1007/s11060-023-04338-y

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