Frequency and Predictors of Acute Hospitalization Before Death in Patients With Glioblastoma.
Glioblastoma (GBM) is a devastating and incurable neuro-oncologic disease, and issues related to the end of life are almost invariably a matter of "when," not a matter of "if." Optimizing symptom management and quality of life in later stages of disease is of the utmost priority.



To examine the frequency of and factors associated with late acute hospital admission before death in patients with GBM.



Case-control study comparing patients with GBM admitted to the hospital within one month of death to those without late hospital admission.



Of 385 GBM patients followed to death at Memorial Sloan Kettering Cancer Center, 164 (42.6%) were admitted within a month of death, most frequently (140, or 85%) to manage neurologic decline. Of these, 56 (34%) had intensive care unit care during this admission and 22 (13%), 18 (11%), and 2 (1%) received mechanical ventilation, enteral feeding tubes, or cardiopulmonary resuscitation, respectively. In multivariable analysis, in-hospital chaplaincy consultation, and participation in a therapeutic clinical trial, both at any time in the GBM disease course, were significantly associated with late hospital admission.



Late hospitalization is frequent in GBM and often involves intensive care unit care in the management of clinical events that are part of the GBM dying process. Patients with a tendency to use religious support and those enrolled in clinical trials may be at greater risk for late hospitalization. Dedicated prospective study is needed to determine predictors of late hospitalization and to examine the impact of late acute medical care on quality of life in GBM.
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Palliative Medicine Service, Division of Survivorship and Supportive Care, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA. Electronic address: diamone1@mskcc.org.
Eli L
EL
Diamond
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Katherine S
KS
Panageas
Department of Neurology, Columbia University Medical Center, New York, New York, USA.
Alexis
A
Dallara
Icahn School of Medicine, Mount Sinai Medical Center, New York, New York, USA.
Ariel
A
Pollock
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Allison J
AJ
Applebaum
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Palliative Medicine Service, Division of Survivorship and Supportive Care, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Alan C
AC
Carver
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Elena
E
Pentsova
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Lisa M
LM
DeAngelis
Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA.
Holly G
HG
Prigerson
D001932:Brain Neoplasms / Q000628:therapy*; D016022:Case-Control Studies; D003422:Critical Care; D005260:Female; D005909:Glioblastoma / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013727:Terminal Care
Malignant brain tumor; glioblastoma; palliative care; quality of life