Clinical tumor progression, infection common causes of death in patients with gliomas

Researchers reported common causes of death and end-of-life care experiences among patients with intracranial high-grade gliomas in a retrospective observational study published in Neurology.

“Uncertainty surrounding end-of-life expectations, including whether death involves physical pain or suffering, may exacerbate anxiety among patients and caregivers, who often ask about end-of-life circumstances in the setting of disease progression,” Marissa Barbaro, MD, of the department of neurology at Columbia University Vagelos College of Physicians and Surgeons in New York, and colleagues wrote. “Therefore, we sought to characterize cause and location of death, as well as frequency of use of palliative measures and resuscitative efforts, among patients with gliomas at a single academic medical center in a systematic and comprehensive manner over a [5]-year period.”

Researchers analyzed data of 152 patients (95 men, 57 women; median age at death, 61.5 years) with intracranial high-grade gliomas at Columbia University Irving Medical Center who died between January 2014 and February 2019 and had an assessment of cause of death, location of death and use of comfort measures and resuscitative efforts.

Results showed clinical tumor progression (n = 117; 77%) represented the most common cause of death among all patients transitioned to comfort measures. Other causes were infection (n = 19; 12.5%), intra-tumoral hemorrhage (n = 5; 3.3%), seizures (n = 8; 5.3%), cerebral edema (n = 4; 2.6%), pulmonary embolism (n = 4; 2.6%), autonomic failure (n = 2; 1.3%) and hemorrhagic shock (n = 2; 1.3%). A total of 10 patients (8.5%) had multiple mortal events. Death at home with hospice occurred among 73 patients (48%). Other locations were inpatient hospice (n = 40; 26.3%); acute care hospital (n = 34; 22.4%), including 27 (17.8%) with and seven (4.6%) without comfort measures; skilled nursing facility (n = 4; 3.3%), including three (2%) with and one (0.7%) without comfort measures; or religious facility (n = 1; 0.7%) with comfort measures. A total of 20 patients received acute cardiac and/or pulmonary resuscitation.

“These results may inform end-of-life expectations by patients and caregivers, fostering care planning and emotional preparedness,” Barbaro and colleagues wrote.