Palliative Care Service Utilization and Advance Care Planning for Adult Glioblastoma Patients: A Systematic Review

Abstract

Glioblastoma (GBM) has a median overall survival of 16–21 months. As patients with GBM suffer concurrently from terminal cancer and a disease with progressive neurocognitive decline, advance care planning (ACP) and palliative care (PC) are critical. We conducted a systematic review exploring published literature on the prevalence of ACP, end-of-life (EOL) services utilization (including PC services), and experiences among adults with GBM. We searched from database inception until 20 December 2020. Preferred reporting items for systematic reviews guidelines were followed. Included studies were assessed for quality using the Newcastle-Ottawa Scale. The 16 articles were all nonrandomized studies conducted in six countries with all but two published in 2014 or later. ACP documentation varied from 4–55%, PC referral was pursued in 39–40% of cases, and hospice referrals were made for 66–76% of patients. Hospitalizations frequently occurred at the EOL with 20–56% of patients spending over 25% of their overall survival time hospitalized. Many GBM patients do not pursue ACP or have access to PC. There is a dearth of focused and high-quality studies on ACP, PC, and hospice use among adults with GBM. Prospective studies that address these and additional aspects related to EOL care, such as healthcare costs and inpatient supportive care needs, are needed.

Supportive care of patients diagnosed with high grade glioma and their carers in Australia

“…Only a small proportion of HPs noted all patients were referred to palliative care. A systematic review of palliative care utilisation by glioblastoma patients identified advance care planning for up to half of patients, palliative care referrals and consultations for a third, and hospice referrals for most, with variable hospice use (38–86%) [ 35 ]. Although it is unclear from our survey whether low referral rates impacted the use of Advance Care Planning, such planning helps meet patients’ end of life preferences and reduces healthcare costs in patients with cognitive impairment or dementia [ 36 ].…”

Glioblastomas

“… On the left, an illustration of the different cell populations composing glioblastoma and its microenvironment, as well as associated blood-brain barrier disruption. On the right, a summary of the different areas covered by the articles in this Special Issue: GBM cells, stem cells, and preclinical studies [ 2 , 3 , 4 , 5 , 6 ], clinical studies [ 7 , 8 ], immunotherapy and new treatments [ 9 , 10 , 11 , 12 ]. Created with BioRender.com.…”

“…Eleven papers are included in this issue [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ], and they range from in vitro and preclinical studies to clinical studies, and to immunotherapy and new potential treatments for glioblastomas ( Figure 1 ).…”

“…Another clinical paper in this Special Issue reviews palliative care (PC) service utilization and advanced care planning (ACP) in GBM patients [ 8 ]. Sixteen articles were selected, all from non-randomized studies conducted in six countries, mostly published in 2014 or later.…”

Comparison of healthcare utilization and life-sustaining interventions between patients with glioblastoma receiving palliative care or not: A population-based study

“…16,17 Although palliative care utilization for patients with glioblastoma has significantly increased in recent years, it is still underutilized in those with severe neurologic symptoms and a poor prognosis. 18 Our study aimed to assess the differences in healthcare utilization within 1 year before death between patients with glioblastoma who received palliative care and who did not, using the data collected retrospectively from the Taiwan Cancer Registry.…”