OS05.5 Pallative care in Brain Tumors: 15 years of activity of a Neuroncological Home Care Service

Abstract

INTRODUCTION: Recent studies report that early integration of palliative care approach with standard oncologic care in cancer patients may have a beneficial effect on quality of life and mood disorders. In Brain Tumor patients, however, the provision of supportive and palliative care often occurs late and the timing and the role of palliative care in brain tumor patients remain to be better defined. Since October 2000 in the Regina Elena National Cancer Institute of Rome, we started a palliative home-care project for patients affected by malignant BTs, with financial support of Regional Health System. The aims of this model of assistance are to meet patient's needs of care during the evolution of the disease, to provide palliative care, to support the families and to facilitate death at home. METHODS: in the first fifteen years of our program 873 patients have been assisted at home and 618 died. Home assistance includes neurological visits, neuro-rehabilitation at home, psychological support for patients and families and nursing assistance. RESULTS: among the 410 patients who were assisted at home until death (410/618, 66%), the most frequent symptoms in the last 4 weeks of life were: epilepsy 37%, headache 36%, drowsiness 85%, dysphagia 85%, death rattle 12%, agitation and delirium 15%. The large majority of BT patients die with a process that has been defined as “peaceful death”, with progressive neurological deterioration. In some case, however, patients may present bad symptom control with agitated death that requires pharmacological sedation (15,7%). The early provision of home palliative care enables family caregivers to continue caring at home until death and allow to discuss timely with patient and family the End of Life Advance Care Planning, avoiding hospitalisation or Emergency room access in case of acute symptoms. CONCLUSION: early integration of palliative care model in the trajectory of desease of Brain Tumor patients is critical to providing more effective support, to enhancing the likelihood of a desired home death and to support the psychological and spiritual needs of patients and families.