Palliative Care for High-Grade Glioma

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Brief Summary WHO Grade III and IV gliomas (high-grade glioma or HGG) are aggressive, malignant primary brain tumors that are devastating for older adult patients and caregivers due to high symptom burden, early physical and cognitive decline, caregiver support needs, and existential distress stemming from life expectancy on the order of months. Palliative care, defined by the National Quality Forum as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and alleviating suffering across the continuum of a patient's illness”, is well-suited to meet the complex needs of these patients. Multiple oncological societies recommend that palliative care be integrated early (within 3 months of diagnosis) into the treatment plan of all cancer patients. Older adults have particularly high palliative care needs, in part due to shorter prognosis and decreased tolerance for standard cancer-directed therapy. Generally, palliative care needs may be addressed through a combination of primary palliative care (delivered by any front-line provider, including neuro- oncologists) and/or specialty palliative care (delivered by a provider or multidisciplinary team with advanced palliative care training and certification). The current literature suggests that patients with HGG do not have all their palliative care needs met through primary palliative care from neuro-oncologists, yet they also are not referred to specialty palliative care until they are actively dying. There is no established model for ensuring their palliative care needs are met throughout the disease course. In this proposal, I present a conceptual model of the barriers to comprehensive, timely palliative care for patients with HGG. My career goal is to improve the delivery of palliative care for older adults with HGG. In this proposal I will: 1) use qualitative methods to assess the range of knowledge, experience, and strength of preferences of older adults with HGG, their caregivers, neuro-oncologists, and palliative medicine specialists regarding the domains of palliative care and the optimal balance of primary and specialty palliative care for each domain; 2) use an existing cohort of patients with HGG from a large health delivery system to measure the extent to which services or care processes in each palliative care domain are delivered, and to analyze the associations between palliative care delivery and overall HGG health care utilization. These two projects will be combined with my career development plan, for which I have identified a team of expert mentors and advisors and am proposing coursework relating to qualitative research methods and implementation science, as well as clinical rotations and didactic learning about core concepts in geriatrics and aging research. This will set me on a path to obtain a future career development award, which is the first step on my path to becoming an independent investigator whose work improves the care of older adults with HGG.