End-of-life care in patients with primary malignant brain tumors: A systematic literature review and analysis.

Abstract

e20703 Background: 80–85% of all adult brain tumors are high-grade glioma (HGG). HGG are typically treated with maximal surgical resection, followed by radiotherapy with concurrent and adjuvant chemotherapy. The median survival for anaplastic glioma is estimated to be 2-5 years and 15 months for patients with glioblastoma. Quality of life (QoL) has become an increasing important outcome assessed in clinical trials as well as in the standard care of brain tumor patients. Despite the inevitable disease trajectory, not much is known about symptoms and needs of brain tumor patients and their caretakers at the end of life. There appears to be a lack of published literature on this important aspect of neuro-oncology. Methods: A systematic literature search was conducted in PubMed and Cochrane covering the years between 1946 through 2012. In total, 7146 article citations were found. After first review 942 abstracts were obtained. Based on content 82 articles were examined separately by both authors and it was agreed to eliminate 67 of them because they did not include a significant number of primary brain tumor patients or the focus was not on end of life care and symptoms. Results: Only 7 of the retained articles contained specific patient data and did not just reflect opinions of authors or reviews of the topic. Only one study was performed prospectively. Three studies assessed symptom management in inpatients, 2 in outpatients and 2 in a combined setting. Studies included between 29 and 169 patients. Drowsiness and loss of consciousness was the most common symptom (85%–90%). Poor communication (64% and 90%), focal deficits (29%– 62%), seizures (3%–67%), dysphagia (10%–85%), headache (4%–62%), and fatigue (25%–67%) were also frequent. Interventions included hydration (87%-93%), urinary catheter (89%), steroids (62%-80%), anti-epileptic drugs (45%-76%), oxygen (48%), tube feeding (13%) and palliative sedation (13%). Conclusions: There is 1 prospective study and only a total of 7 studies describing detailed end of life symptoms. None of the studies addressed caregiver quality of life. More research is needed to develop purposeful interventions to address end of life symptoms and QoL in patients with HGG.