Early palliative care decision in patients with primary brain tumor reduces emergency department visits and hospitalization at the end of life

Purpose Palliative care (PC) remains underutilized among patients with primary brain tumors, despite the life-threatening nature of the disease and the high symptom burden. This study aimed to assess how the timing of a PC decision (i.e., terminate life-prolonging anticancer treatments) is associated with emergency department visits and hospitalizations at the end of life (EOL). Methods This single-center retrospective cohort study included adult patients (≥ 18 years) with primary brain tumor treated at the Comprehensive Cancer Center of Helsinki University Hospital during 2017–2018 who died by the end of 2018. Patients were categorized into “early PC decision” (> 30 days before death) or “late/no PC decision” (≤ 30 days or no decision). We extracted data on hospital resource use from electronic medical records. Results Among 162 patients (mean age 66 years, range 24–97; 57% male), 64% had a documented PC decision, with 43% of the total cohort having an early PC decision. Patients with an early PC decision had significantly fewer emergency department visits (10% vs. 25%; p = 0.015) and fewer hospitalizations (4% vs. 29%; p < 0.001) in their final month of life compared to those with a late/no decision. Overall, 34% of patients visited a dedicated PC unit, with a median of 93 days (range 5-619) from the first PC unit visit to death. Conclusions An early PC decision significantly reduced acute hospital resource use at EOL among brain tumor patients. Nonetheless, approximately one-third of patients had no documented PC decision, and similarly low numbers had PC unit visits, highlighting ongoing gaps in timely PC initiation. ; Peer reviewed