End of life issues in brain tumor patients |
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Authors: | Andrea Pace Cherubino Di Lorenzo Lara Guariglia Bruno Jandolo Carmine M Carapella Alfredo Pompili |
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Institution: | (1) Department of Neuroscience, Palliative Home-Care Unit for Brain Tumor Patients, Regina Elena National Cancer Institute, via Chianesi 53, Rome, 00144, Italy;(2) UCADH, University of Rome “La Sapienza”, Polo Pontino–ICOT, Latina, Italy |
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Abstract: | Despite aggressive antitumor treatment, the prognosis of brain tumor (BT) patients remains poor. In the last stage of disease,
BT patients present severe symptoms due to the growing tumor or to treatment side-effects, which require adequate palliative
management and supportive therapy. However, studies specifically addressing palliative care and end-of-life (EoL) issues in
BT patients are lacking. This study explores symptoms experienced by BT patients in the last weeks of disease and EoL issues
observed in a population of brain tumor patients followed at home until death by a neuro-oncological home care palliative
unit set up in our Institution in 2000. From October 2000 to December 2005, 324 patients affected by brain tumor and discharged
from our Institution were enrolled in a comprehensive program of neuro-oncological home care supported by the Regional Health
System. Out of 324 patients enrolled in the home care program, 260 patients died of which 169 (65%) were assisted at home
until the end of life and have been included in this study. Clinical symptoms, palliative treatments and EoL treatment decisions
were collected from home clinical records. Among the 169 patients assisted at home until death, the most frequent symptoms
observed in the last four weeks of life were: epilepsy 30%, headache 36%, drowsiness 85%, dysphagia 85%, death rattle 12%,
agitation and delirium 15%. Palliative management of brain tumor patients requires a multidisciplinary approach performed
by a well trained neuro-oncology team. Development of home care models of assistance may represent an alternative to in-hospital
care for the management of patients dying of brain tumor and may improve the quality of end-of-life care.
An erratum to this article can be found at |
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Keywords: | Palliative care End of life treatment decisions Brain tumor |
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