LAUSR

To understand patterns of care at end of life in glioma patients. Patients with gliomas often inquire about end-of-life issues. Understanding common clinical outcomes of tumor progression and end-of-life circumstances may reduce anxiety among patients and caregivers and inform care planning. Following IRB approval, we retrospectively analyzed circumstances surrounding death among patients with intracranial gliomas at Columbia University Irving Medical Center from 1/2014-2/2019, including immediate cause and location of death and implementation of palliative measures. Information unavailable from the medical record was supplemented by caregivers. Data were available for 152 patients (95 men, 57 women; median age at death 61.5 years). Failure to thrive with transition to supportive care (n=117, 77%) was the most common immediate cause of death. Others included infection (19, 13%; with pulmonary (12, 8%), urinary tract (5, 3%), CNS (4, 3%), and GI (2, 1%) sources); seizures (8, 5%); intracerebral hemorrhage (5, 3%); cerebral edema (4, 3%); pulmonary embolism (4, 3%); autonomic failure (2, 1%); hemorrhagic shock (2, 1%); respiratory failure of unknown cause (2, 1%); pulmonary edema (1, 1%); and cardiac arrhythmia (1, 1%). Ten patients had multiple causes of death. Seventy-three patients (48%) died at home with hospice. Other locations were inpatient hospice (40, 26%); acute care hospital (34, 22%) including 27 (18%) with and 7 (5%) without comfort measures; skilled nursing facility (4, 3%) including 3 (2%) with and 1 (1%) without comfort measures; or religious facility (1, 1%) with comfort measures. Acute cardiac and/or pulmonary resuscitation was performed in 20 patients (13%); 8 (5%) died with no comfort measures. Failure to thrive with transition to supportive care was the most common (77%) immediate cause of death followed by infection (13%). Hospice and/or palliative measures were implemented in 95% of patients, though resuscitative efforts were performed in 13%.