title: The Last 10 Days of Patients With Glioblastoma: Assessment of Clinical Signs and Symptoms as well as Treatment.
abstract: BACKGROUND
  High-grade gliomas are the most frequent primary brain tumors. Despite improvement in diagnostics and treatment, survival is still poor and quality-of-life issues are of major importance. Little is known regarding the clinical signs and symptoms of dying patients with glioblastoma.
  
  
  OBJECTIVE
  The aim of this study was to investigate signs and symptoms as well as therapeutic strategies in patients with glioblastoma in the end-of-life phase in order to improve end-of-life care.
  
  
  METHODS
  In this prospective single-center study, clinical data were obtained using a standardized protocol. We descriptively analyzed signs, symptoms, and therapeutic strategies on a daily basis.
  
  
  RESULTS
  A total of 57 patients, who died due to glioblastoma in a hospital setting, were included. The most frequent signs and symptoms in the last 10 days before death were decrease in level of consciousness (95%), fever (88%), dysphagia (65%), seizures (65%), and headache (33%). Concerning medication, 95% received opioids. There was a high need for nonsteroidal anti-inflammatory drugs (77%) and anticonvulsants (75%). Steroids were given to 56%.
  
  
  CONCLUSIONS
  Due to a decrease in level of consciousness and cognitive impairment, assessment of clinical signs and symptoms such as headache at the end of life is difficult. Based on the signs and symptoms in the last days before death in patients with glioblastoma, supportive drug treatment remains challenging. Our study emphasizes the importance of standardized guidelines for end-of-life care in patients with glioblastoma.
authors.affiliation: Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria katrin.thier@stpolten.lknoe.at.
authors.forename: Katrin
authors.initials: K
authors.lastname: Thier
authors.affiliation: Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Calabek
authors.affiliation: Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tinchon
authors.affiliation: Department of Neurology, Kaiser-Franz-Josef-Hospital, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Grisold
authors.affiliation: Department of Neurology, University Clinic St Pölten, KLPU and Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, St Pölten, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Oberndorfer
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000927:Anticonvulsants / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000150:complications / Q000503:physiopathology*; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D005440:Fluid Therapy; D005909:Glioblastoma / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D012640:Seizures / Q000188:drug therapy* / Q000209:etiology; D013727:Terminal Care / Q000379:methods*; D014474:Unconsciousness / Q000209:etiology; D055986:Vital Signs
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants
keywords: end of life; glioblastoma; palliative care; supportive care