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Open Access 20-03-2024 | Glioma | Research

Palliative care for in-patient malignant glioma patients in Germany

Authors: Larissa Fink, Birgitt van Oorschot, Christiane von Saß, Maxine Dibué, Marie-Therese Foster, Heidrun Golla, Ronald Goldbrunner, Christian Senft, Aaron Lawson McLean, Martin Hellmich, Nazife Dinc, Raymond Voltz, Heiner Melching, Christine Jungk, Marcel A. Kamp

Published in: Journal of Neuro-Oncology | Issue 2/2024

Abstract

Objective

Malignant gliomas impose a significant symptomatic burden on patients and their families. Current guidelines recommend palliative care for patients with advanced tumors within eight weeks of diagnosis, emphasizing early integration for malignant glioma cases. However, the utilization rate of palliative care for these patients in Germany remains unquantified. This study investigates the proportion of malignant glioma patients who either died in a hospital or were transferred to hospice care from 2019 to 2022, and the prevalence of in-patient specialized palliative care interventions.

Methods

In this cross-sectional, retrospective study, we analyzed data from the Institute for the Hospital Remuneration System (InEK GmbH, Siegburg, Germany), covering 2019 to 2022. We included patients with a primary or secondary diagnosis of C71 (malignant glioma) in our analysis. To refine our dataset, we identified cases with dual-coded primary and secondary diagnoses and excluded these to avoid duplication in our final tally. The data extraction process involved detailed scrutiny of hospital records to ascertain the frequency of hospital deaths, hospice transfers, and the provision of complex or specialized palliative care for patients with C71-coded diagnoses. Descriptive statistics and inferential analyses were employed to evaluate the trends and significance of the findings.

Results

From 2019 to 2022, of the 101,192 hospital cases involving malignant glioma patients, 6,129 (6% of all cases) resulted in in-hospital mortality, while 2,798 (2.8%) led to hospice transfers. Among these, 10,592 cases (10.5% of total) involved the administration of complex or specialized palliative medical care. This provision rate remained unchanged throughout the COVID-19 pandemic. Notably, significantly lower frequencies of complex or specialized palliative care implementation were observed in patients below 65 years (p < 0.0001) and in male patients (p_adjusted = 0.016). In cases of in-hospital mortality due to malignant gliomas, 2,479 out of 6,129 cases (40.4%) received specialized palliative care.

Conclusion

Despite the poor prognosis and complex symptomatology associated with malignant gliomas, only a small proportion of affected patients received advanced palliative care. Specifically, only about 10% of hospitalized patients with malignant gliomas, and approximately 40% of those who succumb to the disease in hospital settings, were afforded complex or specialized palliative care. This discrepancy underscores an urgent need to expand palliative care access for this patient demographic. Additionally, it highlights the importance of further research to identify and address the barriers preventing wider implementation of palliative care in this context.

Baumgarten P, Prange G, Kamp MA, Monden D, Neef V, Schwarzer F, Dubinski D, Dinc N, Weber KJ, Czabanka M, Hattingen E, Ronellenfitsch MW, Steinbach JP, Senft C (2023) Treatment of very elderly glioblastoma patients >/= 75 years of age: whom to treat. J Neurooncol 165:509–515. https://doi.org/10.1007/s11060-023-04518-wCrossRefPubMedPubMedCentral

Berger K, Turowski B, Felsberg J, Malzkorn B, Reifenberger G, Steiger HJ, Budach W, Haussmann J, Knipps J, Rapp M, Hanggi D, Sabel M, Mijderwijk HJ, Kamp MA (2021) Age-stratified clinical performance and survival of patients with IDH-wildtype glioblastoma homogeneously treated by radiotherapy with concomitant and maintenance temozolomide. J Cancer Res Clin Oncol 147:253–262. https://doi.org/10.1007/s00432-020-03334-3CrossRefPubMed

Collins A, Sundararajan V, Brand CA, Moore G, Lethborg C, Gold M, Murphy MA, Bohensky MA, Philip J (2014) Clinical presentation and patterns of care for short-term survivors of malignant glioma. J Neurooncol 119:333–341. https://doi.org/10.1007/s11060-014-1483-5CrossRefPubMed

Earle CC, Neville BA, Landrum MB, Souza JM, Weeks JC, Block SD, Grunfeld E, Ayanian JZ (2005) Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care 17:505–509. https://doi.org/10.1093/intqhc/mzi061CrossRefPubMed

Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ (2017) Integration of Palliative Care into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 35:96–112. https://doi.org/10.1200/JCO.2016.70.1474CrossRefPubMed

Forst D, Adams E, Nipp R, Martin A, El-Jawahri A, Aizer A, Jordan JT (2018) Hospice utilization in patients with malignant gliomas. Neuro Oncol 20:538–545. https://doi.org/10.1093/neuonc/nox196CrossRefPubMed

Herrlinger U, Tzaridis T, Mack F, Steinbach JP, Schlegel U, Sabel M, Hau P, Kortmann RD, Krex D, Grauer O, Goldbrunner R, Schnell O, Bähr O, Uhl M, Seidel C, Tabatabai G, Kowalski T, Ringel F, Schmidt-Graf F, Suchorska B, Brehmer S, Weyerbrock A, Renovanz M, Bullinger L, Galldiks N, Vajkoczy P, Misch M, Vatter H, Stuplich M, Schäfer N, Kebir S, Weller J, Schaub C, Stummer W, Tonn JC, Simon M, Keil VC, Nelles M, Urbach H, Coenen M, Wick W, Weller M, Fimmers R, Schmid M, Hattingen E, Pietsch T, Coch C, Glas M (2019) Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA-09): a randomised, open-label, phase 3 trial. Lancet 393:678–688. https://doi.org/10.1016/s0140-6736(18)31791-4CrossRefPubMed

Holm S (1979) A simple sequentially rejective multiple Test Procedure. Scand J Stat 6:65–70

Institut für das Entgeltsystem im Gesundheitsweisen GmbH (2023) InEK Datenbrowser. https://datenbrowser.inek.org. 2023

10.

Kamp MA, von Sass C, Januzi D, Dibue M, Libourius K, Lawson McLean AC, Baumgarten P, Lawson McLean A, Dinc N, Senft CA (2023) Frequency of social burden and underage children in neuro-oncological patients. J Cancer Res Clin Oncol. https://doi.org/10.1007/s00432-023-05338-1CrossRefPubMedPubMedCentral

11.

Leitlinienprogramm Onkologie, DK-DK-A (2020) Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung, Kurzversion 2.3. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Palliativmedizin/Version_2/LL_Palliativmedizin_Kurzversion_2.3.pdf. Accessed 29.11.2023 2023

12.

Leitlinienprogramm Onkologie, DK-DK-A (2022) Deutsche Krebshilfe, AWMF). Onkologische Qualitätsindikatoren - Leitlinienbasierte Qualitätsindikatoren Im Leitlinienprogramm Onkologie (OL), Version 6. Leitlinienprogramm Onkologie. Deutsche Krebsgesellschaft. Accessed 29.11.2023 2023

13.

Ley A, Kamp M, von Sass C, Hanggi D, Sabel M, Rapp M (2022) Psychooncological distress in low-grade glioma patients-a monocentric study. Acta Neurochir (Wien) 164:713–722. https://doi.org/10.1007/s00701-021-04863-7CrossRefPubMed

14.

Lindskog M, Schultz T, Strang P (2022) Acute healthcare utilization in end-of-life among Swedish brain tumor patients - a population based register study. BMC Palliat Care 21:133. https://doi.org/10.1186/s12904-022-01022-2CrossRefPubMedPubMedCentral

15.

Mijderwijk HJ, Nieboer D, Incekara F, Berger K, Steyerberg EW, van den Bent MJ, Reifenberger G, Hanggi D, Smits M, Senft C, Rapp M, Sabel M, Voss M, Forster MT, Kamp MA (2022) Development and external validation of a clinical prediction model for survival in patients with IDH wild-type glioblastoma. J Neurosurg 1–10. https://doi.org/10.3171/2021.10.JNS211261

16.

Ostrom QT, Price M, Neff C, Cioffi G, Waite KA, Kruchko C, Barnholtz-Sloan JS (2022) CBTRUS Statistical Report: primary brain and other Central Nervous System tumors diagnosed in the United States in 2015–2019. Neuro Oncol 24:v1–v95. https://doi.org/10.1093/neuonc/noac202CrossRefPubMedPubMedCentral

17.

Pace A, Belleudi V, Tanzilli A, Villani V, Poggi FR, Benincasa D, Davoli M, Pinnarelli L (2023) Pattern of care of brain tumor patients in the last months of life: analysis of a cohort of 3045 patients in the last 10 years. Neurol Sci 44:2897–2902. https://doi.org/10.1007/s10072-023-06722-yCrossRefPubMed

18.

Pace A, Dirven L, Koekkoek JAF, Golla H, Fleming J, Ruda R, Marosi C, Le Rhun E, Grant R, Oliver K, Oberg I, Bulbeck HJ, Rooney AG, Henriksson R, Pasman HRW, Oberndorfer S, Weller M, Taphoorn MJB European Association of Neuro-Oncology palliative care task f (2017) European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma. Lancet Oncol 18:e330–e340. https://doi.org/10.1016/S1470-2045(17)30345-5

19.

Pando A, Patel AM, Choudhry HS, Eloy JA, Goldstein IM, Liu JK (2023) Palliative Care effects on Survival in Glioblastoma. Who Receives Palliat Care? World Neurosurg 170:e847–e857. https://doi.org/10.1016/j.wneu.2022.11.143CrossRef

20.

Pearson K (1900) X. on the criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling. Lond Edinb Dublin Philosophical Magazine J Sci 50:157–175. https://doi.org/10.1080/14786440009463897CrossRef

21.

Pearson K (1992) On the Criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from Random Sampling. In: Kotz S, Johnson NL (eds) Breakthroughs in statistics: methodology and distribution. Springer New York, New York, NY, pp 11–28. doi:https://doi.org/10.1007/978-1-4612-4380-9_2CrossRef

22.

Rapp M, Schipmann S, Hoffmann K, Wiewrodt R, Steiger HJ, Kamp M, Stummer W, Wiewrodt D, Sabel M (2018) Impact of distress screening algorithm for psycho-oncological needs in neurosurgical patients. Oncotarget 9:31650–31663. https://doi.org/10.18632/oncotarget.25833CrossRefPubMedPubMedCentral

23.

Renovanz M, Tsakmaklis H, Soebianto S, Neppel I, Nadji-Ohl M, Beutel M, Werner A, Ringel F, Hickmann AK (2018) Screening for distress in patients with intracranial tumors during the first 6 months after diagnosis using self-reporting instruments and an expert rating scale (the basic documentation for psycho-oncology short form - PO-Bado SF). Oncotarget 9:31133–31145. https://doi.org/10.18632/oncotarget.25763CrossRefPubMedPubMedCentral

24.

Saunders C (2001) The evolution of palliative care. J R Soc Med 94:430–432. https://doi.org/10.1177/014107680109400904CrossRefPubMedPubMedCentral

25.

Stabellini N, Krebs H, Patil N, Waite K, Barnholtz-Sloan JS (2021) Sex differences in Time to treat and outcomes for gliomas. Front Oncol 11:630597. https://doi.org/10.3389/fonc.2021.630597CrossRefPubMedPubMedCentral

26.

Stupp R, Taillibert S, Kanner A, Read W, Steinberg D, Lhermitte B, Toms S, Idbaih A, Ahluwalia MS, Fink K, Di Meco F, Lieberman F, Zhu JJ, Stragliotto G, Tran D, Brem S, Hottinger A, Kirson ED, Lavy-Shahaf G, Weinberg U, Kim CY, Paek SH, Nicholas G, Bruna J, Hirte H, Weller M, Palti Y, Hegi ME, Ram Z (2017) Effect of Tumor-Treating Fields Plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a Randomized Clinical Trial. JAMA 318:2306–2316. https://doi.org/10.1001/jama.2017.18718CrossRefPubMedPubMedCentral

27.

Sundararajan V, Bohensky MA, Moore G, Brand CA, Lethborg C, Gold M, Murphy MA, Collins A, Philip J (2014) Mapping the patterns of care, the receipt of palliative care and the site of death for patients with malignant glioma. J Neurooncol 116:119–126. https://doi.org/10.1007/s11060-013-1263-7CrossRefPubMed

28.

Tian J, Luo Y, Xiang J, Tang J (2017) Combined treatment for non-small cell lung cancer and breast cancer patients with brain metastases with whole brain radiotherapy and temozolomide: a systematic review and meta-analysis. J Neurooncol 135:217–227. https://doi.org/10.1007/s11060-017-2572-zCrossRefPubMed

29.

van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, Bernsen HJ, Frenay M, Tijssen CC, Grisold W, Sipos L, Enting RH, French PJ, Dinjens WN, Vecht CJ, Allgeier A, Lacombe D, Gorlia T, Hoang-Xuan K (2013) Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 31:344–350. https://doi.org/10.1200/JCO.2012.43.2229CrossRefPubMed

30.

van den Bent MJ, Tesileanu CMS, Wick W, Sanson M, Brandes AA, Clement PM, Erridge S, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Ruda R, Weller M, McBain C, Reijneveld J, Enting RH, Caparrotti F, Lesimple T, Clenton S, Gijtenbeek A, Lim E, Herrlinger U, Hau P, Dhermain F, de Heer I, Aldape K, Jenkins RB, Dubbink HJ, Kros JM, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, French P, Baumert BG (2021) Adjuvant and concurrent temozolomide for 1p/19q non-co-deleted anaplastic glioma (CATNON; EORTC study 26053– 22054): second interim analysis of a randomised, open-label, phase 3 study. Lancet Oncol 22:813–823. https://doi.org/10.1016/S1470-2045(21)00090-5CrossRefPubMedPubMedCentral

31.

Weller M, van den Bent M, Preusser M, Le Rhun E, Tonn JC, Minniti G, Bendszus M, Balana C, Chinot O, Dirven L, French P, Hegi ME, Jakola AS, Platten M, Roth P, Ruda R, Short S, Smits M, Taphoorn MJB, von Deimling A, Westphal M, Soffietti R, Reifenberger G, Wick W (2021) EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol 18:170–186. https://doi.org/10.1038/s41571-020-00447-zCrossRefPubMed

32.

Wu A, Ruiz Colon G, Aslakson R, Pollom E, Patel CB (2021) Palliative Care Service utilization and advance Care Planning for Adult Glioblastoma patients: a systematic review. Cancers (Basel) 13. https://doi.org/10.3390/cancers13122867

33.

Wu A, Ugiliweneza B, Wang D, Hsin G, Boakye M, Skirboll S (2022) Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a SEER-Medicare retrospective study. Neurooncol Pract 9:299–309. https://doi.org/10.1093/nop/npac026CrossRefPubMedPubMedCentral

34.

Yang W, Warrington NM, Taylor SJ, Whitmire P, Carrasco E, Singleton KW, Wu N, Lathia JD, Berens ME, Kim AH, Barnholtz-Sloan JS, Swanson KR, Luo J, Rubin JB (2019) Sex differences in GBM revealed by analysis of patient imaging, transcriptome, and survival data. Sci Transl Med 11:eaao5253. https://doi.org/10.1126/scitranslmed.aao5253CrossRefPubMedPubMedCentral

Title: Palliative care for in-patient malignant glioma patients in Germany
Authors: Larissa Fink
Birgitt van Oorschot
Christiane von Saß
Maxine Dibué
Marie-Therese Foster
Heidrun Golla
Ronald Goldbrunner
Christian Senft
Aaron Lawson McLean
Martin Hellmich
Nazife Dinc
Raymond Voltz
Heiner Melching
Christine Jungk
Marcel A. Kamp
Publication date: 20-03-2024
Publisher: Springer US
Keywords: Glioma
Glioma
Glioma
Glioblastoma
Glioblastoma
Glioblastoma
Published in: Journal of Neuro-Oncology / Issue 2/2024
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-024-04611-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Palliative care for in-patient malignant glioma patients in Germany

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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