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Patterns of care at end of life for people with primary intracranial tumors: lessons learned

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Abstract

To determine the variability in processes of care in the last 6 months of life experienced by patients dying of primary intracranial tumors and potential predictors of place of death, a death-backwards cohort was assembled using historical data and 1,623 decedents were identified. 90 % of people had ≥1 admission to an acute care hospital and 23 % spent ≥3 months of their last 6 months of life in acute care. 44 % had ≥1 ER visits and 30 % were admitted ≥1 times to ICU. Only 18 % had a home visit by a physician. 10 % died at home but 49 % died in hospital, while 40 % died in a palliative care facility. Age, comorbidities, and being diagnosed with grade 4 astrocytoma were associated with greater burden of care. Level of care burden and age were associated with higher odds of dying in a treatment intensive place of death, being diagnosed with grade 4 astrocytoma had opposite effect. Despite valuable research efforts to improve the treatment of primary intracranial tumors that focus on biology, refinements to surgery, radiation, and chemotherapy, there is also room to improve aspects of care at the end of life situation. An integrative approach for this patients’ population, from diagnosis to death, could potentially reduce the care burden in the final period on the health care system, patient’s family and improve access to a better place of death.

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Notes

  1. Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière.

  2. Régie de l'Assurance Maladie du Québec.

  3. Centre Local De Santé Communautaire

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Acknowledgment

This work was supported by the Canadian Institutes of Health Research, Dr. Bruno Gagnon is a recipient of a the “Chercheur-clinicien Boursier” award from the Fonds de recherche Québec en Santé.

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Authors and Affiliations

  1. Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada

    Abdulrahman Alturki, Susan C. Scott, Lyne Nadeau & Nancy Mayo

  2. Department of Neurology and Neurosurgery, The Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, QC, Canada

    Abdulrahman Alturki & Kevin Petrecca

  3. Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia

    Abdulrahman Alturki

  4. Département de médecine familiale et de médecine d’urgence, Centre de Recherche sur le Cancer, Universite Laval, Centre de recherche du CHU de Québec, Quebec City, QC, Canada

    Bruno Gagnon

Authors
  1. Abdulrahman Alturki
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  2. Bruno Gagnon
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  3. Kevin Petrecca
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  4. Susan C. Scott
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  5. Lyne Nadeau
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  6. Nancy Mayo
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Corresponding author

Correspondence to Abdulrahman Alturki.

Appendix

Appendix

See Tables 5, 6, 7, and 8

Table 5 ICD-9 and ICD-10 codes defining included persons with a single intracranial tumor
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Table 6 Histology codes defining included persons with primary intracranial tumors
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Table 7 Codes defining included persons with complication of primary intracranial tumors
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Table 8 Number of subjects per care burden estimate
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Alturki, A., Gagnon, B., Petrecca, K. et al. Patterns of care at end of life for people with primary intracranial tumors: lessons learned. J Neurooncol 117, 103–115 (2014). https://doi.org/10.1007/s11060-014-1360-2

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  • DOI: https://doi.org/10.1007/s11060-014-1360-2

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