End-of-Life Care in Glioblastoma: A Population-Based Study.

Abstract

Background: The end-of-life (EoL) phase of care is inevitable for glioblastoma (GBM) patients; however, it lacks standardization. This study aimed to characterize the utilization of care at EoL in GBM patients, focusing on trends over time, regional variability, and the influence of socioeconomic factors.

Methods: This was a retrospective population-based cohort study of all patients with GBM treated in Ontario between 1994 - 2018 using administrative health data and registries available at ICES (formerly the Institute for Clinical Evaluative Sciences). The proportion of patients with palliative care, supportive care, and in-hospital deaths by year of diagnosis was estimated, and trends assessed with the Cochrane-Armitage trend test.

Results: The cohort included 9,013 GBM patients. There was an increase in supportive care components over the study time-period (29.6% in 1994 - 1998 to 60.2% in 2014 - 2018; p < 0.0001). There was a simultaneous decrease in in-hospital deaths (50.5% in 1994 - 1998 to 21.4% in 2014 - 2018; p<0.001) and hospitalizations within 30 days before death (65.5% in 1994-1998 to 51.7% in 2014 - 2018, p<0.001). This coincided with an increased in chemotherapy administration within 14 days of death and ICU admissions within 30 days of death over the studied period of time. Patient neighborhood income level and geographic location influenced EoL care patterns with regards to both supportive and aggressive components.

Conclusions: Over time there was an expansion of both inpatient and outpatient palliative care use at EoL. Rurality and neighborhood income quintile significantly influenced the utilization of these resources, underscoring the need for standardized EoL care practices.