Trends in inpatient palliative care use for primary brain malignancies

Kubendran, Sindhu; Schockett, Erica; Jackson, Erin; Huynh-Le, Minh Phuong; Roberti, Fabio; Rao, Yuan James; Ojong-Ntui, Martin; Goyal, Sharad

doi:10.1007/s00520-021-06255-0

Cited by 6 publications

(13 citation statements)

References 17 publications

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“…From a total of 915 records retrieved, after duplicate exclusion and screening from abstracts, 363 relevant articles were screened from full text; of those, 15 articles [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] were adjudicated relevant for inclusion in this review and provided the basis for data and discussion presented on the topic ( Table 1 ). Twelve studies were conducted in a single center, and only three were multicentric studies.…”

Section: Resultsmentioning

confidence: 99%

“…This may help interpreting conflicting data on palliative care consultations and their association with outcomes. As an example, it may be confusing to know that in a 10-year cohort of patients with primary brain tumors, patients receiving palliative care received less oncologic treatment (e.g., brain surgery, chemotherapy, or radiation) than those not receiving palliative care, but they were more likely to receive life-sustaining treatments (e.g., intubation, mechanical ventilation and nutritional support) [ 9 ]. Written protocols regarding the goals of care and the resuscitation dispositions [ 23 ] in the case of withdrawal of life support may be of practical help, together with a careful selection of timing of life support withdrawal according to caregivers’ readiness to accept end of life.…”

Section: Discussionmentioning

confidence: 99%

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Palliative Care and End-of-Life Issues in Patients with Brain Cancer Admitted to ICU

et al. 2023

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Background and Objectives: Palliative care is an interdisciplinary medical specialty focused on improving the quality of life of critically ill patients, including those with frailty, during their illness. Materials and Methods: We conducted an extensive literature review on Pubmed focusing on palliative care in neuro-oncology patients admitted to intensive care units (ICUs). Results: We identified 967 articles and, after excluding 952 articles in accordance with the PRISMA flow chart, we included a total of 15 articles in the final selection. The potential role of palliative care in neuro-oncology appears necessary to ensure comprehensive end-of-life patient care. However, this seems underestimated and poorly applied, especially in the context of intensive care units. Medical personnel also face ethical dilemmas, considering not only the pathology but also the socio-spiritual context of the patient. In addition, caregivers’ understanding of prognosis and realistic goals is critical for optimal end-of-life management. Conclusions: The provision of palliative care to neuro-oncological patients admitted to ICU is a complex challenge supported by fragmented evidence. Additional research on palliative care and communication about end-of-life care in the neuro-oncology and neuro-ICU setting is needed.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Palliative Care and End-of-Life Issues in Patients with Brain Cancer Admitted to ICU

et al. 2023

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“…The early implementation of palliative care is requested by the reduced cognitive ability of brain tumor patients [ 9 ] and by the heavy distress that is experienced by caregivers. Moreover, in the context of the heavy socioeconomic burden of cancer [ 10 , 11 ], it has been shown that early palliative care activation reduces the costs of hospitalizations [ 12 ] and leads to an increase in home discharge for end-of-life care [ 13 ]. In most of the cases discussed here, caregivers had to face a sudden worsening of patients’ neurological conditions without having the possibility to set up adequate domestic assistance: this can explain the low rate of home deaths in our series.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical Defeats: Critically Ill Patients and the Role of Palliative Care Service

D’Alessandris

Ricciotti

Palombi

et al. 2022

JPM

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The onco-functional balance in neuro-oncology requires maximizing tumor removal while rigorously preserving patients’ neurological status. When postoperative worsening prevents the implementation of oncologic treatments, palliative care service offers an individualized path for symptom and psychosocial distress relief. Here, we report on a series of 25 patients operated on for malignant brain tumor who did not undergo adjuvant treatments after neurosurgery; they represented 3.9% of the whole institutional surgical series. These patients were significantly older and had a lower preoperative Karnofsky performance status than the whole cohort. Importantly, in 22 out of 25 (88%) cases, a surgical complication occurred, leading to clinical worsening in 21 patients. For the end of life, the majority of patients chose a hospice care facility (72%). While a careful selection of brain tumor patients candidate to neurosurgery is required, palliative care service provided invaluable help in coping with patients’ and caregivers’ needs.

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“…Studies have shown reduced costs for cancer patients receiving inpatient palliative care [ 21 ]. Utilization of inpatient palliative care consults increased for patients with primary brain malignancies from 2.3% in 2007 to 11.3% in 2016, indicating a substantial increase but still far below the number of patients who could benefit from services to manage symptoms and improve quality of life [ 22 ]. Studies have shown that oncology readmission rates can be reduced by palliative care consultation, mainly due to discharge to hospice [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

et al. 2022

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Eighty-one percent of persons living with cancer have an emergency department (ED) visit within the last 6 months of life. Many cancer patients in the ED are at an advanced stage with high symptom burden and complex needs, and over half is admitted to an inpatient setting. Innovative models of care have been developed to provide high quality, ambulatory, and home-based care to persons living with serious, life-limiting illness, such as advanced cancer. New care models can be divided into a number of categories based on either prognosis (e.g., greater than or less than 6 months), or level of care (e.g., lower versus higher intensity needs, such as intravenous pain/nausea medication or frequent monitoring), and goals of care (e.g., cancer-directed treatment versus symptom-focused care only). We performed a narrative review to (1) compare models of care for seriously ill cancer patients in the ED and (2) examine factors that may hasten or impede wider dissemination of these models.

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Trends in inpatient palliative care use for primary brain malignancies

Cited by 6 publications

References 17 publications

Palliative Care and End-of-Life Issues in Patients with Brain Cancer Admitted to ICU

Palliative Care and End-of-Life Issues in Patients with Brain Cancer Admitted to ICU

Neurosurgical Defeats: Critically Ill Patients and the Role of Palliative Care Service

Palliative care models for patients living with advanced cancer: a narrative review for the emergency department clinician

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