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Fereydooni S, Valdez C, William L, Malik D, Mehra S, Judson B. Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer. Otolaryngol Head Neck Surg 2024; 171:1069-1082. [PMID: 38796734 DOI: 10.1002/ohn.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Characterizing factors associated with palliative care (PC) use in patients with stage III and VI head and neck cancer using Anderson's behavioral model of health service use. STUDY DESIGN A retrospective study of the 2004 to 2020 National Cancer Database.gg METHODS: We used multivariate logistic regression to assess the association of predisposing, enabling, and need factors with PC use. We also investigated the association of these factors with interventional PC type (chemotherapy, radiotherapy, surgery) and refusal of curative treatment in the last 6 months of life. RESULTS Five percent of patients received PC. "Predisposing factors" associated with less PC use include Hispanic ethnicity (adjusted odds ratio [aOR], 086; 95% confidence interval [CI], 0.76-0.97) and white and black race (vs white: aOR, 1.14; 95% CI, 1.07-1.22). "Enabling factors" associated with lower PC include private insurance (vs uninsured: aOR, 064; 95% CI, 0.53-0.77) and high-income (aOR, 078; 95% CI, 0.71-0.85). "Need factors" associated with higher PC use include stage IV (vs stage III cancer: aOR, 2.25; 95% CI, 2.11-2.40) and higher comorbidity index (vs Index 1: aOR, 1.58; 95% CI, 1.42-1.75). High-income (aOR, 0.78; 95% CI, 0.71-0.85) and private insurance (aOR, 0.6; 95% CI, 0.53, 0.77) were associated with higher interventional PC use and lower curative treatment refusal (insurance: aOR, 0.82; 95% CI, 0.55, 0.67; income aOR, 0.48; 95% CI, 0.44, 0.52). CONCLUSION Low PC uptake is attributed to patients' race/culture, financial capabilities, and disease severity. Culturally informed counseling, clear guidelines on PC indication, and increasing financial accessibility of PC may increase timely and appropriate use of this service.
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Affiliation(s)
- Soraya Fereydooni
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline Valdez
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Devesh Malik
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
- Otolaryngology Surgery, New Haven, Connecticut, USA
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Fink L, van Oorschot B, von Saß C, Dibué M, Foster MT, Golla H, Goldbrunner R, Senft C, Lawson McLean A, Hellmich M, Dinc N, Voltz R, Melching H, Jungk C, Kamp MA. Palliative care for in-patient malignant glioma patients in Germany. J Neurooncol 2024; 167:323-338. [PMID: 38506960 PMCID: PMC11023986 DOI: 10.1007/s11060-024-04611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Malignant gliomas impose a significant symptomatic burden on patients and their families. Current guidelines recommend palliative care for patients with advanced tumors within eight weeks of diagnosis, emphasizing early integration for malignant glioma cases. However, the utilization rate of palliative care for these patients in Germany remains unquantified. This study investigates the proportion of malignant glioma patients who either died in a hospital or were transferred to hospice care from 2019 to 2022, and the prevalence of in-patient specialized palliative care interventions. METHODS In this cross-sectional, retrospective study, we analyzed data from the Institute for the Hospital Remuneration System (InEK GmbH, Siegburg, Germany), covering 2019 to 2022. We included patients with a primary or secondary diagnosis of C71 (malignant glioma) in our analysis. To refine our dataset, we identified cases with dual-coded primary and secondary diagnoses and excluded these to avoid duplication in our final tally. The data extraction process involved detailed scrutiny of hospital records to ascertain the frequency of hospital deaths, hospice transfers, and the provision of complex or specialized palliative care for patients with C71-coded diagnoses. Descriptive statistics and inferential analyses were employed to evaluate the trends and significance of the findings. RESULTS From 2019 to 2022, of the 101,192 hospital cases involving malignant glioma patients, 6,129 (6% of all cases) resulted in in-hospital mortality, while 2,798 (2.8%) led to hospice transfers. Among these, 10,592 cases (10.5% of total) involved the administration of complex or specialized palliative medical care. This provision rate remained unchanged throughout the COVID-19 pandemic. Notably, significantly lower frequencies of complex or specialized palliative care implementation were observed in patients below 65 years (p < 0.0001) and in male patients (padjusted = 0.016). In cases of in-hospital mortality due to malignant gliomas, 2,479 out of 6,129 cases (40.4%) received specialized palliative care. CONCLUSION Despite the poor prognosis and complex symptomatology associated with malignant gliomas, only a small proportion of affected patients received advanced palliative care. Specifically, only about 10% of hospitalized patients with malignant gliomas, and approximately 40% of those who succumb to the disease in hospital settings, were afforded complex or specialized palliative care. This discrepancy underscores an urgent need to expand palliative care access for this patient demographic. Additionally, it highlights the importance of further research to identify and address the barriers preventing wider implementation of palliative care in this context.
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Affiliation(s)
- Larissa Fink
- Center for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Am Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, University Hospital Würzburg, Würzburg, , Germany
| | - Christiane von Saß
- Center for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Am Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
| | - Maxine Dibué
- Center for Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Marie-Therese Foster
- Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Ronald Goldbrunner
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Christian Senft
- Center of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Aaron Lawson McLean
- Center of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nazife Dinc
- Center of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (CTCC), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heiner Melching
- German Association for Palliative Care Medicine, Berlin, Germany
| | - Christine Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
- Department of Neurosurgery, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Marcel A Kamp
- Center for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Am Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
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Yekula A, Gessler DJ, Ferreira C, Shah R, Reynolds M, Dusenbery K, Chen CC. GammaTile ® (GT) as a brachytherapy platform for rapidly proliferating glioblastomas: from case series to clinical trials. J Neurooncol 2024; 166:441-450. [PMID: 38281303 DOI: 10.1007/s11060-023-04545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Radiation plays a central role in glioblastoma treatment. Logistics related to coordinating clinic visits, radiation planning, and surgical recovery necessitate delay in radiation delivery from the time of diagnosis. Unimpeded tumor growth occurs during this period, and is associated with poor clinical outcome. Here we provide a pilot experience of GammaTile ® (GT), a collagen tile-embedded Cesium-131 (131Cs) brachytherapy platform for such aggressive tumors. METHODS We prospectively followed seven consecutive patients (2019-2023) with newly diagnosed (n = 3) or recurrent (n = 4) isocitrate dehydrogenase wild-type glioblastoma that grew > 100% in volume during the 30 days between the time of initial diagnosis/surgery and the radiation planning MRI. These patients underwent re-resection followed by GT placement. RESULTS There were no surgical complications. One patient developed right hemiparesis prior to re-resection/GT placement and was discharged to rehabilitation, all others were discharged home-with a median hospital stay of 2 days (range: 1-5 days). There was no 30-day mortality and one 30-day readmission (hydrocephalus, requiring ventriculoperitoneal shunting (14%)). With a median follow-up of 347 days (11.6 months), median progression free survival of ≥ 320 days (10.6 months) was achieved for both newly and recurrent glioblastoma patients. The median overall survival (mOS) was 304 and 347 days (10 and 11.5 mo) for recurrent and newly diagnosed glioblastoma patients, respectively. CONCLUSION Our pilot experience suggests that GT offers favorable local control and safety profile for patients afflicted with rapidly proliferating glioblastomas and lay the foundation for future clinical trial design.
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Affiliation(s)
- Anudeep Yekula
- Department of Neurosurgery, University of Minnesota Medical School, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA
| | - Dominic J Gessler
- Department of Neurosurgery, University of Minnesota Medical School, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA
| | - Clara Ferreira
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Rena Shah
- Department of Oncology, North Memorial Health, Robbinsdale, MN, USA
| | - Margaret Reynolds
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota Medical School, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA.
- Department of Neurosurgery, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.
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Kamp MA, Golla H, Dinc N, Goldbrunner R, Senft C, Hellmich M, Voltz R. Letter to the Editor Regarding: "Palliative Care Effects on Survival in Glioblastoma: Who Receives Palliative Care?". World Neurosurg 2023; 178:270-272. [PMID: 37803664 DOI: 10.1016/j.wneu.2023.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Marcel A Kamp
- Center for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Rüdersdorf bei Berlin, Germany.
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nazife Dinc
- Center of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ronald Goldbrunner
- Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Christian Senft
- Center of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne (CTCC), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Shlobin NA, Bernstein M. Letter to the Editor Regarding: "Palliative Care Effects on Survival in Glioblastoma: Who Receives Palliative Care?". World Neurosurg 2023; 173:294-295. [PMID: 37189315 DOI: 10.1016/j.wneu.2023.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Pando A. In Reply to the Letter to the Editor Regarding "Palliative Care Effects on Survival in Glioblastoma: Who Receives Palliative Care?". World Neurosurg 2023; 173:296. [PMID: 37189316 DOI: 10.1016/j.wneu.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Alejandro Pando
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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