Causes of Death and End-of-Life Care in Patients With Intracranial High-Grade Gliomas: A Retrospective Observational Study.

Autor:	Barbaro M; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Blinderman CD; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Iwamoto FM; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Kreisl TN; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Welch MR; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Odia Y; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Donovan LE; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Joanta-Gomez AE; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Evans KA; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY., Lassman AB; From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY. abl7@cumc.columbia.edu.
Jazyk:	angličtina
Zdroj:	Neurology [Neurology] 2022 Jan 18; Vol. 98 (3), pp. e260-e266. Date of Electronic Publication: 2021 Nov 18.
DOI:	10.1212/WNL.0000000000013057
Abstrakt:	Background and Objectives: To understand patterns of care and circumstances surrounding end of life in patients with intracranial gliomas. Methods: We retrospectively analyzed end-of-life circumstances in patients with intracranial high-grade gliomas at Columbia University Irving Medical Center who died from January 2014 to February 2019, including cause of death, location of death, and implementation of comfort measures and resuscitative efforts. Results: There were 152 patients (95 men, 57 women; median age at death 61.5 years, range 24-87 years) who died from January 2014 to February 2019 with adequate data surrounding end-of-life circumstances. Clinical tumor progression (n = 117, 77.0%) was the most common cause of death, with all patients transitioned to comfort measures. Other causes included, but were not limited to, infection (19, 12.5%); intratumoral hemorrhage (5, 3.3%); seizures (8, 5.3%); cerebral edema (4, 2.6%); pulmonary embolism (4, 2.6%); autonomic failure (2, 1.3%); and hemorrhagic shock (2, 1.3%). Multiple mortal events were identified in 10 (8.5%). Seventy-three patients (48.0%) died at home with hospice. Other locations were inpatient hospice (40, 26.3%); acute care hospital (34, 22.4%), including 27 (17.8%) with and 7 (4.6%) without comfort measures; skilled nursing facility (4, 3.3%), including 3 (2.0%) with and 1 (0.7%) without comfort measures; or religious facility (1, 0.7%) with comfort measures. Acute cardiac or pulmonary resuscitation was performed in 20 patients (13.2%). Discussion: Clinical tumor progression was the most common (77.0%) cause of death, followed by infection (12.5%). Hospice or comfort measures were ultimately implemented in 94.7% of patients, although resuscitation was performed in 13.2%. Improved understanding of circumstances surrounding death, frequency of use of hospice services, and frequency of resuscitative efforts in patients with gliomas may allow physicians to more accurately discuss end-of-life expectations with patients and caregivers, facilitating informed care planning. (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu