End-of-Life Care for Older Adults with Brain Tumours

Overview of Brain Tumours

The end-of-life care provided to older adults has recently garnered attention, particularly regarding the risk factors for aggressive treatment and the associated costs. This emphasizes the necessity for families to be informed about what to expect when caring for an older adult diagnosed with a debilitating condition, such as a brain tumour. Brain tumours are categorized into two types: primary and secondary. A primary brain tumour originates in the brain itself, while a secondary brain tumour arises from cancer cells that spread from another primary site in the body.

Impact on Older Adults

More than half of patients diagnosed with malignant brain tumours are over the age of 65. These patients often face a more rapid decline and experience more severe symptoms compared to younger individuals. The consequences can be debilitating, leaving many bedridden and reliant on end-of-life care. This type of care can be aggressive, financially burdensome, and may contribute to a negative psychological state for these patients.

Research Findings

A study published in the June 2017 issue of JAMA Oncology analyzed data from a Medicare database for brain tumour patients aged 65 and older between 2012 and 2015. The study included 1,323 patients with either primary or secondary brain tumours. Researchers examined the costs incurred in the 30 days leading up to the patients’ deaths, including expenses billed to Medicare, emergency department visits, intensive care admissions, and hospital stays.

Cost Comparisons and Hospitalization Trends

The results indicated that patients with secondary brain tumours were more likely to require emergency visits or hospitalization compared to those with primary tumours, despite similar costs to Medicare for both groups. Notably, older adults with primary brain tumours were found to have an increased likelihood of hospital admissions, particularly among males. Additionally, as age increased, patients with secondary brain tumours experienced greater severity of illness and higher rates of hospitalization. Approximately half of the 1,323 patients utilized hospital care during their final 30 days, with end-of-life costs ranging from $13,000 to $16,000. The data also revealed two significant associations: higher hospital usage among men and those of younger age. Over time, hospital costs for these patients tended to rise, potentially reflecting the growing need for care as neurological symptoms worsened.

Implications for Families and Healthcare Providers

The rising costs associated with end-of-life care can be unexpected for families, particularly those unable to afford such expenses for their elderly relatives. This observation underscores the importance of healthcare professionals being more attentive to the quality of life for older adults. By doing so, they can better assist families in emotionally and financially preparing for the challenges of funding necessary care.

Source

Dr. Apollina Sharma, MBBS, GradDip EXMD. “Hospital-Based End-of-Life Care and Costs for Older Patients With Malignant Brain Tumors.” JAMA Oncology (2017).