Objective

Malignant gliomas impose a significant symptomatic burden on patients and their families. Current guidelines recommend palliative care for patients with advanced tumors within eight weeks of diagnosis, emphasizing early integration for malignant glioma cases. However, the utilization rate of palliative care for these patients in Germany remains unquantified. This study investigates the proportion of malignant glioma patients who either died in a hospital or were transferred to hospice care from 2019 to 2022, and the prevalence of in-patient specialized palliative care interventions.

Methods

In this cross-sectional, retrospective study, we analyzed data from the Institute for the Hospital Remuneration System (InEK GmbH, Siegburg, Germany), covering 2019 to 2022. We included patients with a primary or secondary diagnosis of C71 (malignant glioma) in our analysis. To refine our dataset, we identified cases with dual-coded primary and secondary diagnoses and excluded these to avoid duplication in our final tally. The data extraction process involved detailed scrutiny of hospital records to ascertain the frequency of hospital deaths, hospice transfers, and the provision of complex or specialized palliative care for patients with C71-coded diagnoses. Descriptive statistics and inferential analyses were employed to evaluate the trends and significance of the findings.

Results

From 2019 to 2022, of the 101,192 hospital cases involving malignant glioma patients, 6,129 (6% of all cases) resulted in in-hospital mortality, while 2,798 (2.8%) led to hospice transfers. Among these, 10,592 cases (10.5% of total) involved the administration of complex or specialized palliative medical care. This provision rate remained unchanged throughout the COVID-19 pandemic. Notably, significantly lower frequencies of complex or specialized palliative care implementation were observed in patients below 65 years (p < 0.0001) and in male patients (p_adjusted = 0.016). In cases of in-hospital mortality due to malignant gliomas, 2,479 out of 6,129 cases (40.4%) received specialized palliative care.

Conclusion

Despite the poor prognosis and complex symptomatology associated with malignant gliomas, only a small proportion of affected patients received advanced palliative care. Specifically, only about 10% of hospitalized patients with malignant gliomas, and approximately 40% of those who succumb to the disease in hospital settings, were afforded complex or specialized palliative care. This discrepancy underscores an urgent need to expand palliative care access for this patient demographic. Additionally, it highlights the importance of further research to identify and address the barriers preventing wider implementation of palliative care in this context.

中文翻译：

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德国住院恶性胶质瘤患者的姑息治疗

客观的

恶性神经胶质瘤给患者及其家人带来了显着的症状负担。目前的指南建议在诊断后八周内对晚期肿瘤患者进行姑息治疗，强调恶性胶质瘤病例的早期整合。然而，德国这些患者的姑息治疗的利用率仍然无法量化。本研究调查了 2019 年至 2022 年在医院死亡或转入临终关怀的恶性胶质瘤患者的比例，以及住院专业姑息治疗干预措施的流行情况。

方法

在这项横断面回顾性研究中，我们分析了医院薪酬系统研究所（InEK GmbH，德国西格堡）2019 年至 2022 年的数据。我们纳入了初次或二次诊断为 C71（恶性胶质瘤）的患者我们的分析。为了完善我们的数据集，我们确定了具有双编码主要和次要诊断的病例，并排除了这些病例，以避免最终统计中的重复。数据提取过程涉及对医院记录的详细审查，以确定医院死亡的频率、临终关怀转移以及为 C71 编码诊断的患者提供复杂或专门的姑息治疗。采用描述性统计和推论分析来评估研究结果的趋势和意义。

结果

2019年至2022年，在涉及恶性胶质瘤患者的101,192例医院病例中，6,129例（占所有病例的6%）导致院内死亡，而2,798例（占所有病例的6%）导致临终关怀转移。其中，10,592 例（占总数的 10.5%）涉及复杂或专门的姑息医疗护理。在整个 COVID-19 大流行期间，这一拨备率保持不变。值得注意的是，在 65 岁以下的患者 ( p  < 0.0001) 和男性患者 (p_调整后= 0.016)中观察到复杂或专门的姑息治疗实施频率明显较低。在因恶性神经胶质瘤导致的院内死亡病例中，6,129 例中有 2,479 例 (40.4%) 接受了专门的姑息治疗。

结论

尽管恶性胶质瘤预后不良且症状复杂，但只有一小部分患者接受了高级姑息治疗。具体而言，只有约 10% 的恶性神经胶质瘤住院患者和约 40% 在医院环境中死于该疾病的患者接受了复杂或专门的姑息治疗。这种差异凸显了迫切需要扩大该患者群体的姑息治疗机会。此外，它还强调了进一步研究的重要性，以查明和解决在这方面阻碍姑息治疗更广泛实施的障碍。