Palliative care interventions and outcome in patients with glioblastoma – a retrospective, single-center study

BACKGROUND: Patients with glioblastoma (GB) not only suffer from a life-threatening oncological disease but also present with severe neurological symptoms and high psychosocial distress. The unfavorable prognosis and the early decline in neurological functions and activities of daily living, such as mobility, lead to a significant deterioration in quality of life aspects. The need for palliative care (PC) therefore arises at an early stage and increases as the disease progresses but is often inadequately assessed and treated. METHODS: In this single-center, retrospective study, we investigated prognostic factors, survival outcomes and neuro-oncologically focused primary palliative care (nPPC) as well as specialized palliative care (SPC) interventions. Pearson's Chi-square test and an univariable and multivariable binary logistic regression analysis were used to test the independence between categorical variables and the correlation between SPC and tumor-specific therapy prior to death. The Kaplan-Meier method and a multivariable Cox regression analysis were performed to estimate the impact of SPC on survival. RESULTS: A cohort of 274 patients with GB was investigated, of whom 251 (91.6%) received nPPC and 210 (76.6%) SPC. Patients with SPC (p < 0.001; OR: 0.302; 95% CI: 0.157-0.584) and patients with methylation of the MGMT promoter region (p = 0.005; OR: 0.375; 95% CI: 0.190-0.739) were less likely to receive a tumor-specific therapy in the 30 days prior to death. Median overall survival was 16.9 months (95% CI: 14.5-19.3 months) for patients with SPC (n = 210) vs. 12.9 months (95% CI: 10.8-15.1 months) for patients without (n = 64) (p = 0.100; not significant). The Cox proportional hazards model demonstrated that SPC significantly correlates with longer overall survival (p = 0.017; HR: 0.707; 95% CI: 0.532-0.939). CONCLUSION: This study revealed a broad availability of PC interventions for patients with GB. After adjustment of known prognostic factors, an association between SPC supply and prolonged OS was observed. Utmost efforts should be made to incorporate PC into the care of every patient within a standardized framework. Data on PC in patients with GB is still rare; therefore, further research should be made to improve PC in this highly burdened patient group.