From the Division of Neuro-Oncology (M.B., F.M.I., T.N.K., M.R.W., Y.O., L.E.D., K.A.E., A.B.L.), Department of Neurology, Herbert Irving Comprehensive Cancer Center (C.D.B., F.M.I., T.N.K., M.R.W., L.E.D., A.E.J.-G., A.B.L.), and Division of Hematology/Oncology (C.D.B.), Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital; Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola (M.B.), NYU Long Island School of Medicine, NYU Langone Health; Novartis AG (T.N.K.), East Hanover, NJ; Miami Cancer Institute (Y.O.), Baptist Health South Florida, FL; Department of Veterans Affairs (L.E.D.), James J. Peters Medical Center, Bronx (L.E.D.); and Montefiore Health System (K.A.E.), Bronx, NY.
Neurology. 2022 Jan 18;98(3):e260-e266. doi: 10.1212/WNL.0000000000013057. Epub 2021 Nov 18.
To understand patterns of care and circumstances surrounding end of life in patients with intracranial gliomas.
We retrospectively analyzed end-of-life circumstances in patients with intracranial high-grade gliomas at Columbia University Irving Medical Center who died from January 2014 to February 2019, including cause of death, location of death, and implementation of comfort measures and resuscitative efforts.
There were 152 patients (95 men, 57 women; median age at death 61.5 years, range 24-87 years) who died from January 2014 to February 2019 with adequate data surrounding end-of-life circumstances. Clinical tumor progression (n = 117, 77.0%) was the most common cause of death, with all patients transitioned to comfort measures. Other causes included, but were not limited to, infection (19, 12.5%); intratumoral hemorrhage (5, 3.3%); seizures (8, 5.3%); cerebral edema (4, 2.6%); pulmonary embolism (4, 2.6%); autonomic failure (2, 1.3%); and hemorrhagic shock (2, 1.3%). Multiple mortal events were identified in 10 (8.5%). Seventy-three patients (48.0%) died at home with hospice. Other locations were inpatient hospice (40, 26.3%); acute care hospital (34, 22.4%), including 27 (17.8%) with and 7 (4.6%) without comfort measures; skilled nursing facility (4, 3.3%), including 3 (2.0%) with and 1 (0.7%) without comfort measures; or religious facility (1, 0.7%) with comfort measures. Acute cardiac or pulmonary resuscitation was performed in 20 patients (13.2%).
Clinical tumor progression was the most common (77.0%) cause of death, followed by infection (12.5%). Hospice or comfort measures were ultimately implemented in 94.7% of patients, although resuscitation was performed in 13.2%. Improved understanding of circumstances surrounding death, frequency of use of hospice services, and frequency of resuscitative efforts in patients with gliomas may allow physicians to more accurately discuss end-of-life expectations with patients and caregivers, facilitating informed care planning.
了解颅内胶质瘤患者临终关怀的模式和相关情况。
我们回顾性分析了 2014 年 1 月至 2019 年 2 月期间在哥伦比亚大学欧文医学中心因颅内高级别胶质瘤死亡的患者的临终关怀情况，包括死亡原因、死亡地点以及临终关怀措施和复苏努力的实施情况。
共有 152 名患者（95 名男性，57 名女性；死亡时的中位年龄为 61.5 岁，范围为 24-87 岁）在 2014 年 1 月至 2019 年 2 月期间死亡，并有足够的数据围绕临终关怀情况进行分析。临床肿瘤进展（n = 117，77.0%）是最常见的死亡原因，所有患者均接受了临终关怀措施。其他死因包括但不限于感染（19 例，12.5%）；肿瘤内出血（5 例，3.3%）；癫痫发作（8 例，5.3%）；脑水肿（4 例，2.6%）；肺栓塞（4 例，2.6%）；自主神经衰竭（2 例，1.3%）；和出血性休克（2 例，1.3%）。10 例（8.5%）患者存在多种致死因素。73 例（48.0%）患者在家中接受临终关怀服务后死亡。其他地点包括住院临终关怀（40 例，26.3%）；急性护理医院（34 例，22.4%），其中 27 例（17.8%）接受了临终关怀措施，7 例（4.6%）未接受；康复护理机构（4 例，3.3%），其中 3 例（2.0%）接受了临终关怀措施，1 例（0.7%）未接受；或宗教场所（1 例，0.7%）接受临终关怀措施。20 例（13.2%）患者接受了急性心肺复苏。
临床肿瘤进展是最常见的（77.0%）死亡原因，其次是感染（12.5%）。尽管 13.2%的患者进行了复苏，但 94.7%的患者最终接受了临终关怀或舒适护理措施。更好地了解死亡相关情况、临终关怀服务的使用频率以及胶质瘤患者复苏努力的频率，可能使医生能够更准确地与患者和护理人员讨论临终期望，从而促进知情的护理计划。
