Outcomes of inpatient chemoradiotherapy for patients with newly diagnosed glioblastoma and significant functional impairment

Abstract Background Clinical outcomes in patients with glioblastoma and low Karnofsky Performance Scale (KPS) in the inpatient setting are rarely described. Limited survival data and high symptom burden complicate decision-making. This study describes patient-centered outcomes in functionally debilitated patients with newly diagnosed glioblastoma following cancer-directed treatment. Methods We retrospectively reviewed charts of patients with newly diagnosed glioblastoma who received radiotherapy (RT) while hospitalized. Patient, tumor, and treatment characteristics were included in univariable Cox regression and logistic models to assess associations with overall survival (OS) and discharge home. Multivariable models included factors significant on univariable analysis. OS was estimated by the Kaplan-Meier method. Results Of 52 patients (median age: 68 years, range: 21-85), median KPS was 50 (range: 30-60). All underwent RT and 50 (96%) received concurrent temozolomide; 12 (23%) received bevacizumab, and 46 (88%) completed planned RT. Median length of stay (LOS) was 29 days (range: 20-65). Only 40% of patients were able to participate in decision-making. Specialty palliative care consultation was provided to 16 (31%). Median OS was 5.82 months. In multivariable analysis, lower KPS remained the sole factor significantly associated with increased risk of death (P = .002) and decreased odd of discharge home (P = .02). Conclusion Inpatient treatment for functionally disabled patients with glioblastoma was associated with prolonged LOS and poor outcomes. These findings highlight opportunities for early incorporation of specialty palliative care to multimodal cancer-directed therapies to optimize symptom management, elicit patient values and preferences, and facilitate goal-concordant decision-making. Prospective studies are necessary to identify predictors of functional recovery and treatment options.