Abstract 1277P
Background
Patients with Glioblastoma Multiforme (GBM) have a prognosis of 16-21 months and high care needs due to progressive neurological deficits, cognitive impairment, and behavioural change. They often do not express the usual symptoms generally associated with advanced incurable cancer. They therefore represent a challenge to the classic palliative care assessment of needs. We aim to review patients with GBM who were referred to a hospital specialist palliative care (HSPC) service in a quaternary centre to inform service development.
Methods
Data on diagnosis and patient care was extracted from the HSPC database and the Neuro-Oncology Multidisciplinary Meeting (MDM) in 2021.
Results
In 2021 165 patients were discussed at the MDM. 62% opted to have systemic therapy locally. The HSPC reviewed 31 patients with GBM. The median age was 57 years. 42% had a resection and 39% had biopsy only. 71% had both chemotherapy and radiotherapy, 3.2% and 6.5% surgery and radiotherapy only respectively. 19.3% had no disease targeted treatment 42% of patients were transferred to hospice after HSPC review. A further 25.8% had a HSPC facilitated discharge to home or nursing home (9.7 %). 19.3% died in hospital. Median number of days from MDM to death was 288 (range 7 - 2032). Median number of days from SPC referral to death was 26 (range 1 – 243). Table: 1277P
Reported symptom burden at time of referral to HSPC
| SYMPTOM | Percentage |
| Functional decline / increased dependancy | 48 |
| Cognitive impairment | 35 |
| Speech disturbance | 22 |
| Seizures | 42 |
| Hemiparesis / focal weakness | 29 |
| Visual disturbance | 9 |
| Personality / behavioural change | 16 |
| Headaches | 9 |
| Dizzyness | 6 |
| Fatigue | 9 |
| Ataxia | 12 |
| Nausea / vomiting | 6 |
Conclusions
The high rate of functional and cognitive impairment shown in this patient cohort reflects published literature. Despite anticipated trajectory of decline, patients were referred late to HSPC and referral numbers are low compared to numbers discussed at MDT. Most patients in this cohort required hospice admission at end of life reflecting the complexity of their care. Earlier referral to HSPC prior to cognitive decline may facilitate more meaningful patient engagement with HSPC and allow opportunities for family support. Low HSPC staffing levels may be an unrecognised cause of the delayed referrals, and may negatively impact patients' experience of their final months.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Beaumont Hospital.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.