title: Integration of palliative care into the neuro-oncology practice: patterns in the United States.
abstract: BACKGROUND
  Between 80%-85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life.
  
  
  METHODS
  A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice.
  
  
  RESULTS
  Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey.
  
  
  CONCLUSIONS
  Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.
authors.affiliation: Departments of Neurosurgery and Neurology , Henry Ford Health System, Detroit, Michigan.
authors.forename: Tobias
authors.initials: T
authors.lastname: Walbert
keywords: end-of-life; glioblastoma; glioma; palliative care; supportive care