Table 2.

Summary of the literature on end-of-life supportive care needs and health care utilization in HGG.

Author (Year)	Country	Number of Centers	Study Type	Number of Participants	Key Findings
Thier (2016) [16]	Austria	1	Retrospective analysis	57 patients with GBM	• Identifies most common symptoms and medications in last 10 days of life
Sizoo (2010) [17]	Netherlands	1	Retrospective analysis	55 patients with HGG	• Depressed mental status, dysphagia were most common symptoms in final week of life
Oberndorfer (2008) [23]	Austria	1	Retrospective chart review	29 patients with GBM	Health care utilization (medications, diagnostic tests, procedures) increased with proximity to death Mean time from end of cancer-directed therapy to death was 10 weeks
Diamond (2017) [24]	USA	1	Retrospective data analysis	385 GBM patients	42.6% of patients were admitted within 30 days of death 34% of admitted patients had ICU-level care 13% had mechanical ventilation, 1% had CPR
Sizoo (2014) [27]	N/A	N/A	Systematic Review	17 studies addressing the end-of-life phase for HGG patients	Symptom burden at the end of life is high and burdensome for patients and caregivers Functional and cognitive decline are significant issues HGG patients have ACP later in their disease course than other patients with neurologic disease
Koekkoek (2016) [50]	N/A	N/A	Narrative Review	N/A	Summarizes literature on end-of-life symptom management in HGG Recommends early ACP Reviews caregiver needs
Sizoo (2012) [51]	Netherlands	3	Cross-sectional survey	101 providers 50 relatives	25% of caregivers viewed patients as having died without dignity Goals of care discussions were reported as limited Preserved communication, positive relationships with health care providers, and lack of health care transitions were associated with dignified death
Koekkoek (2014) [52]	Netherlands Austria Scotland	7	Cross-sectional survey	207 caregivers of HGG decedents	• Predictors caregiver satisfaction with end-of-life care include dying in preferred location; symptom control; meeting of informational needs
Sundararajan (2014) [53]	Australia	Many	Retrospective cohort	678 malignant glioma patients	26% of patients died outside the hospital 49% died in a palliative care/hospice setting 25% died in an acute hospital bed
Alturki (2014) [54]	Canada	Many	Retrospective analysis	1623 decedents with primary intracranial tumors	90% of patients were admitted to hospital in last 6mo of life 23% spent ≥3 months in acute care in last 6mo 49% died in hospital, 10% at home, 40% in palliative care facility
Collins (2014) [55]	Australia	Many	Retrospective cohort	482 malignant glioma patients who died within 120 days of diagnosis	62% of patients who died during diagnosis admission was admitted to a palliative care bed; 38% died in an acute hospital bed 12% of patients who survived diagnosis admission had a palliative care consultation Presence of cognitive or behavioral symptoms was strongest predictor of death during diagnosis admission (OR 3.1)

GBM: Glioblastoma; HGG: High-grade glioma; ACP: Advance care planning; ICU: Intensive care unit; CPR: Cardiopulmonary resuscitation.