P15.16.B ASSESSING THE RELATIONSHIP OF PATIENT CHARACTERISTICS, SYMPTOM BURDEN, PLACE OF DEATH, AND THEIR IMPLICATIONS FOR END-OF-LIFE CARE IN PATIENTS WITH GLIOMAS: A SINGLE-CENTER OBSERVATIONAL STUDY

Abstract BACKGROUND Patients with gliomas, particularly those of higher grades, experience a high symptom burden and have amongst the poorest survival rates in oncology. Neurological deterioration profoundly affects quality of life, especially during the end-of-life (EOL) phase. Understanding the relationship between patient characteristics, symptom burden and place of death offers opportunities to optimize palliative care provision. MATERIALS AND METHODS This retrospective, single-center observational study analyzed 394 patients with gliomas treated at the Comprehensive Cancer Centre Zurich (CCCZ) between 2015 and 2023. Data were extracted from medical records, focusing on demographics, disease characteristics, symptoms in the final three months of life, cause and place of death. Statistical analysis, including cross-tabulation, was used to assess associations between variables. RESULTS The median age at diagnosis was 60 years (interquartile range (IQR), 50-69) and the median age at death was 62 (IQR, 52-70) years. The median overall survival was 1.49 (IQR, 0.97-2.46) years. The majority of patients (n=347; 88%) had WHO grade 4 gliomas, predominantly glioblastomas. Symptom burden in the last three months of life was high, with 261 patients (66%) experiencing motor dysfunction, 190 (48%) neurocognitive decline, 164 (42%) vision impairment, and 155 (39%) speech difficulties, respectively. Seizures were reported in 77 patients (20%). Symptom co-occurrence was significant, particularly between motor dysfunction and neurocognitive impairment. 180 patients (46%) had a burden of four or more recorded symptoms. Place of death was identified in 179 patients (45%). Among these, 58 patients (32%) died in inpatient palliative care, 46 patients (26%) at home, 28 patients (16%) on other inpatient wards, and 28 patients (16%) in hospice. WHO grade 4 tumors and a higher symptom burden were both independently associated with inpatient death (p<0.05). While the majority of patients (n=185; 67.5%) received specialist care, referral to palliative care services occurred late in the disease trajectory for most patients, typically within 90 days before death. Advance care planning (ACP) was rarely available (4.9%), and EoL decision-making documents were generally lacking. CONCLUSION This study highlights the urgent need for earlier palliative care integration into routine neurological and radio-oncological clinical care of patients with gliomas with high symptom burden at EoL. Facilitating ACP and enabling home deaths may help align care with patient preferences, while recognizing that those with high-grade disease and severe symptom load remain at greater risk of institutional EoL care and place of death.