Integrated early palliative care for patients with newly diagnosed glioblastoma: The GLIOSUPPORT feasibility study.

Abstract

Background: Early palliative care improves the quality of life (QoL) and survival in patients with cancer; however, its effects in patients with glioblastoma remain unclear. The GLIOSUPPORT study assessed the feasibility (adherence; primary objective) of an early palliative care program integrated into the standard glioblastoma care pathway. Secondary objectives included the description of the patients' characteristics, QoL, and neuropsychological changes over time, end-of-life decisions, end-of-life treatments, and family carers' perceptions/experiences.

Methods: This interventional, prospective, longitudinal, feasibility study was conducted in a French comprehensive cancer center. Thirty-five patients with newly diagnosed glioblastoma were required to reach an adherence rate of 60%. Adherence was defined as going to 3 palliative care visits scheduled every 12 weeks. Baseline characteristics were compared in patients who did and did not adhere to the palliative care program. Minimal clinically important differences and cut-offs were used to quantify QoL changes.

Results: The adherence rate was 60% (95% CI [42.1%-76.1%]), indicating that the program was feasible. Visual disturbances, communication/initiation deficits, and anxiety were more frequent in the group that did not adhere to the program. Emotional and social functioning, pain, appetite loss, constipation, and headache increased over time (clinically significant differences), whereas neuropsychological disturbances did not change. Half of the participants identified a family proxy and 8.6% wrote advance directives. One month before death, 28.6% of patients were receiving cancer treatment.

Conclusions: Integrating early palliative care in glioblastoma management is feasible. The potential benefits on QoL, mood, and survival must now be evaluated in a larger randomized controlled trial.