Palliative Care Effects on Survival in Glioblastoma: Who Receives Palliative Care?

BACKGROUND: High-grade glioma has a poor overall survival with profoundly negative effects on the patient's quality of life and their caregivers. In this study, we investigate the factors associated with receiving palliative care in patients diagnosed with glioblastoma (GBM) and the association of receiving or not receiving palliative care with overall survival. METHODS: The National Cancer Database was analyzed for patterns of care in patients ≥18 years old who were diagnosed with histologically confirmed grade IV GBM between 2004 and 2017. All statistical analyses were conducted based on univariate and multivariate regression models. RESULTS: A total of 85,380 patients with the diagnosis of GBM were identified. Of the study population, 2803 patients (3.28%) received palliative therapy. On multivariate logistic regression analysis, age ≥70 years (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.04-1.58; P < 0.001), Medicare (OR, 1.348; CI, 1.13-1.61; P = 0.001), tumor size ≥5 cm (OR, 1.15; CI, 1.01-1.31; P = 0.036), tumor multifocality (OR, 1.69; CI, 1.47-1.96; P < 0.001), lobe overlapping tumor (OR, 2.09; CI, 1.13-3.86; P = 0.018), Charlson-Deyo score >0, receiving treatment at a nonacademic/research program, and medium volume of cancers managed at the treatment facility (OR, 1.19; CI, 1.02-1.38; P = 0.026) were independent risk factors associated with an increased chance of receiving palliative care. In contrast, a household income of ≥$40,227 and high volume of cancer managed at the treatment facility (OR, 0.75; CI, 0.58-0.96; P = 0.02) were independent risk factors associated with decreased palliative care. Patients who received no palliative care had a 2-year overall survival longer than those who received palliative care (22% vs. 8.8%; P < 0.001). In patients receiving palliative care, those who received recommended treatment had a 2-year overall survival longer than those who declined part or whole recommended treatment (9.1% vs. 3.8%; P = 0.009). CONCLUSIONS: In patients with high-grade glioma, receiving palliative care is associated with decreased survival. When receiving palliative care, recommended treatment increases the number of patients who survive more than 2 years approximately 3-fold compared with those declining part or whole treatment.

Quality Assessment of Spinal Cord Injury Patient Education Resources.

STUDY DESIGN: Analysis of spinal cord injury patient education resources. OBJECTIVE: To assess the quality of online patient education materials written about spinal cord injury. SUMMARY OF BACKGROUND DATA: The use of online materials by health care consumers to access medical information presents unique challenges. Most Americans have access to the Internet and frequently turn to it as a first-line resource. METHODS: The quality of online patient education materials was evaluated via a readability analysis. Materials provided by the National Institute of Neurological Disorders and Stroke; Centers for Disease Control and Prevention; American Association of Neurological Surgeons; The National Spinal Cord Injury Association; Mayo Clinic; U.S. Department of Veterans Affairs; Kessler Institute for Rehabilitation; American Academy of Neurology; Paralyzed Veterans of America; and the Shepherd Center were assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. Unnecessary formatting was removed and the readability was evaluated with the spelling and grammar function. RESULTS: A total of 104 sections from 10 different Web sites were analyzed. Overall, the average values of the Flesch-Kincaid Grade Level (11.9) and Flesch Reading Ease (40.2) indicated that most Americans would not be able to fully comprehend this material. CONCLUSION: Results indicate that the language used on materials provided by the aforementioned sites is perhaps too advanced for the average American to fully comprehend. The quality of these education resources may be improved via Web site revisions, which might be beneficial for improved patient utilization. LEVEL OF EVIDENCE: 2.

Quality assessment of online patient education resources for peripheral neuropathy.

Given its practicality, the internet is a primary resource for patients afflicted with diseases like peripheral neuropathy. Therefore, it is important that the readily available online resources on peripheral neuropathy are tailored to the general public, particularly concerning readability. Patient education resources were downloaded from the US National Library of Medicine, Mayo Clinic, National Institute of Neurological Disorders and Stroke, Neuropathy.org, GBS/CIDP Foundation International, Hereditary Neuropathy Foundation, Charcot-Marie-Tooth Association, Foundation for Peripheral Neuropathy, and Neuropathy Action Foundation websites. All patient education material related to peripheral neuropathy was evaluated for its level of readability using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level. The FRE scores averaged 43.4 with only the US National Library of Medicine scoring above 60 (76.5). The Flesch-Kincaid Grade Level scores averaged 11.0. All scores were above a seventh-grade level except the US National Library of Medicine, which had a score of a fifth-grade reading level. Most Americans may not fully benefit from patient education resources concerning peripheral neuropathy education on many of the websites. Only the US National Library of Medicine, which is written at a fifth-grade level, is likely to benefit the average American.