Early Palliative Care Consultation in Glioblastoma

Objective: To evaluate the feasibility and utility of early outpatient palliative care (PC) consultation in glioblastoma. Background: Early PC in selected malignancies improves symptom burden and depression while reducing hospitalizations, inpatient deaths and aggressive end of life care. The value of early PC in glioblastoma is not well described. Design/Methods: PC consultation (within 1 month of diagnosis) became standard of care in our outpatient neuro-oncology clinic in September 2015. Patients with newly diagnosed glioblastoma were enrolled in an IRB-approved study to collect data regarding clinical characteristics, feasibility of PC, advance directives (AD), and end of life outcomes. Results: 50% (13/26) of patients had a PC consult. In those without PC consultation, 2 accepted the consultation but cancelled the visit, 4 declined, and the consultation was deferred in 7 patients due to: travel burden (5), physician concern (1), and patient time burden (1). Median time to PC consultation was 21 days (range 5–152). 7/13 had a follow-up visit scheduled; 5 attended those visits and 2 cancelled. Patients without scheduled follow-up (6) were asked to follow-up PRN, yet no PRN visits were scheduled. Goals of care/AD were discussed in 100% of visits, followed by symptom management (84%), emotional well-being/coping (32%), family support (26%), and prognosis (10%). AD were documented prior to 3 rd oncology visit for 10/13 (77%) who had PC consultation compared to 5/13 (38%) without PC. Conclusions: Only half of patients had PC consultation and even fewer attended follow-up visits. Compliance with early PC consultation is challenging due to patient, physician, and geographic barriers. Goals of care discussions and AD documentation are key accomplishments of PC visits, but only half of patients were able to realize this benefit. Future work should integrate PC principles, such as advance care planning, into neuro-oncology practice. Enrollment for this study is ongoing; additional feasibility and outcomes data will be presented. Disclosure: Dr. Hemminger has nothing to disclose. Dr. Pittman has nothing to disclose. Dr. Serventi has nothing to disclose. Dr. Korones has nothing to disclose. Dr. Holloway has received personal compensation for activities with Milliman Guideline, Inc. as a consultant. Dr. Mohile has received personal compensation for activities with Novocure as an advisor.