Hospitalization burden and survival among older glioblastoma patients.
BACKGROUND
Half of all glioblastoma patients are at least 65 years old. The frequency and duration of hospitalization from disease- and treatment-related morbidity in this population are unknown.


METHODS
We performed a retrospective cohort study among patients aged 65 years and older with glioblastoma diagnosed between 1999 and 2007 using SEER-Medicare linked data. Diagnoses and procedures were identified using administrative claims data. Logistic regression was performed to identify predictors of high hospitalization burden.


RESULTS
Among the 5029 patients in the cohort, 52% were ages 65-74, and 52% were male. Twenty-six percent of patients underwent extensive resection, 72% received radiotherapy, and 18% received temozolomide. Median survival was 4.9 months. Among all patients, 21% were hospitalized at least 30 cumulative days between diagnosis and death, and 22% of all patients spent at least one-fourth of their remaining lives as inpatients. Higher comorbidity score (adjusted hazard ratio [AHR], 1.72; 95% CI, 1.42-2.07) and black race (AHR, 1.56; 95% CI, 1.11-2.18) were associated with an increased risk of being hospitalized for at least 25% of remaining life, whereas radiation (AHR, 0.49; 95% CI, 0.42-0.58), temozolomide (AHR, 0.31; 95% CI, 0.23-0.42), and extensive surgery (AHR, 0.83; 95% CI, 0.69-0.99) were associated with a decreased risk.


CONCLUSIONS
These data highlight the burden of hospitalization faced by a large proportion of older glioblastoma patients. In the setting of short survival, strategies to reduce the amount of time these patients spend hospitalized are urgently needed, to help maintain quality of life at the end of life.
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Hospital, Boston, Massachusetts (N.D.A.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Y.W., C.Z., F.D.); Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts (D.S.).
Nils D
ND
Arvold
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Hospital, Boston, Massachusetts (N.D.A.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Y.W., C.Z., F.D.); Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts (D.S.).
Yun
Y
Wang
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Hospital, Boston, Massachusetts (N.D.A.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Y.W., C.Z., F.D.); Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts (D.S.).
Cory
C
Zigler
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Hospital, Boston, Massachusetts (N.D.A.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Y.W., C.Z., F.D.); Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts (D.S.).
Deborah
D
Schrag
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Hospital, Boston, Massachusetts (N.D.A.); Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Y.W., C.Z., F.D.); Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts (D.S.).
Francesca
F
Dominici
D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000401:mortality* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate
elderly; glioblastoma; hospitalization; survival; temozolomide