Acute care in glioblastoma: the burden and the consequences

Abstract

Background: The utilization of inpatient medical services by patients with glioblastoma (GBM) is not well studied. We sought to describe causes, frequency, and outcomes of acute care visits in GBM.

Methods: We conducted a retrospective study of 158 GBM patients at the University of Rochester over 5 years. Electronic medical records were reviewed to identify all local and outside acute care visits. Acute care visits were defined as any encounter resulting in an emergency department visit or inpatient admission.

Results: Seventy-one percent (112/158) of GBM patients had 235 acute care visits corresponding to 163 hospitalizations (69%) and 72 emergency department visits (31%). Sixty-three percent of patients had multiple visits. Admission diagnoses were seizure (33%), neurosurgical procedure (15%), infection (12%), focal neurologic symptoms (9%), and venous thromboembolism (VTE, 9%). Forty-six patients had 1 or more visits for seizures. Median time to first acute care visit was 65.6 days and 22% of patients had an acute care visit within 30 days of diagnosis. Median length of stay was 5 days. Thirty-five percent of admitted patients were discharged home; 62% required a higher level of care than prior to admission (23% were discharged home with services, 17% to a nursing facility, 16% to hospice, 6% to acute rehab) and 3% died. Thirty-eight percent of patients had ACV within 30 days of death. Median survival was 14 months for patients who had acute care visits and 22.2 months for patients who did not.

Conclusion: The majority of GBM patients utilize acute care, most commonly for seizures. The high number of emergency department visits, short length of stay, and many patients discharged home suggest that some acute care visits may be avoidable.

Keywords: glioblastoma; health services; neuro-oncology; palliative care; seizures.

Fig. 1

Cumulative frequency of acute care visits by month following diagnosis. Most visits took place in the first year following diagnosis. Fifty percent of visits had occurred by 7 months after diagnosis and more than 70% by 12 months.

Fig. 2

Indications for acute care utilization in glioblastoma. VTE, Venous thromboembolism; AMS, Altered mental status; HLC, Higher level of care. The majority of 235 acute care visits were for neurologic reasons. Seizures were the most common cause for acute care utilization in patients with glioblastoma.

Fig. 3

Percent survival in patients with ACV vs patients without ACV. ACV, Acute care visits. Kaplan Meier survival curve comparing patients with ACV to patients without ACV. Median survival was 14 months in the group of patients with ACV versus 22.2 months in patients who had no hospital visits. (P = .47).

Fig. 4

Percent of Survival Time Spent Utilizing Acute Care. ACV = Acute Care Visits. Each line on the x-axis represents the 112 patients who had an acute care visit. The y-axis demonstrates the percentage of their survival time spent in the hospital. 20% of patients spend greater than 10% of their survival in an acute care setting.