title: The end-of-life phase of high-grade glioma patients: a systematic review.
abstract: BACKGROUND
  High-grade gliomas (HGG) are rare and incurable; yet, these neoplasms result in a disproportionate share of cancer morbidity and mortality. Treatment of HGG patients is directed not merely towards prolonging life but also towards quality of life, which becomes the major goal in the end of life (EOL). The latter has received increasing attention over the last decade.
  
  
  METHODS
  We reviewed the literature related to the EOL phase of HGG patients from 1966 up to April 2012. Articles were retrieved from PubMed, Embase, Cinahl, PsycINFO and Cochrane database. We then selected papers for analysis using pre-determined inclusion criteria and subtracted information on the topics of interest.
  
  
  RESULTS
  The search yielded 695 articles, of which 17 were classified eligible for analysis according to pre-defined inclusion criteria. Reviewed topics were symptoms and signs, quality of life and quality of dying, caregiver burden, organization and location of palliative care, supportive treatment, and EOL decision making. Nearly all identified studies were observational, with only two non-randomized intervention studies. Symptom burden is high in the EOL phase and affects the quality of life of both patient and carer. Palliative care services are more intensively used compared to other cancer patients. Cognitive deficits increase as the disease progresses, hampering communication and decision making.
  
  
  CONCLUSIONS
  The EOL phase of HGG is substantially different from other patient groups, and more clinical studies in HGG on supportive medication, advance care planning and decision making are required. The organization of care, development of guidelines and interventions to decrease caregiver burden in the EOL phase are critical as well.
authors: Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands, e.m.sizoo@gmail.com.
authors: Eefje M
authors: EM
authors: Sizoo
authors: H Roeline W
authors: HR
authors: Pasman
authors: Linda
authors: L
authors: Dirven
authors: Christine
authors: C
authors: Marosi
authors: Wolfgang
authors: W
authors: Grisold
authors: Günther
authors: G
authors: Stockhammer
authors: Jonas
authors: J
authors: Egeter
authors: Robin
authors: R
authors: Grant
authors: Susan
authors: S
authors: Chang
authors: Jan J
authors: JJ
authors: Heimans
authors: Luc
authors: L
authors: Deliens
authors: Jaap C
authors: JC
authors: Reijneveld
authors: Martin J B
authors: MJ
authors: Taphoorn
mesh_terms: D032722:Advance Care Planning; D017028:Caregivers; D003657:Decision Making; D005260:Female; D005910:Glioma / Q000473:pathology / Q000523:psychology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D011788:Quality of Life; D013727:Terminal Care