• Oliver Heese, Eva Vogeler, Tobias Martens, Oliver Schnell, Jörg-Christian Tonn, Matthias Simon, Johannes Schramm, Dietmar Krex, Gabriele Schackert, Thomas Reithmeier, Guido Nikkhah, Michael Sabel, Hans-Jakob Steiger, Uwe Schlegel, Markus Löffler, Michael Weller, Manfred Westphal, and German Glioma Network.
• Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. oliver.heese@helios-kliniken.de
• Neuro-oncology. 2013 Sep 1;15(9):1251-6.

BackgroundThe prognosis for glioma remains dismal, and little is known about the final disease phase. To obtain information about this period, we surveyed caregivers of patients who were registered in the German Glioma Network and who died from the disease.MethodsA questionnaire with 15 items, focusing on medical, logistic, and mental health support and symptom control during the final 4 weeks, was sent to caregivers. For some of the questions, a scale from 1 (inadequate) to 10 (excellent) was used.ResultsOf 1655 questionnaires, 605 were returned (36.6%) and evaluated. We found that 67.9% of the patients were taken care of at home for the last 4 weeks; 47.7% died at home, 22.6% died in hospitals, and 19.3% died in hospice facilities. Medical support was provided by general practitioners in 72.3% of cases, by physicians affiliated with a nursing home or hospice in 29.9%, and by general oncologists in 17%. Specialized neuro-oncologists were involved in 6%. The caregivers ranked the medical support with a mean of 7.2 (using a 10-point scale), nursing service with 8.1, and mental health support with 5.5. In 22.9% of cases, no support for the caregivers themselves was offered by medical institutions.ConclusionsAlthough these data reflect the caregivers' subjective views, they are useful in understanding and improving current patterns of care. While patients and their caregivers are supported mainly by neuro-oncologists for most of the disease phase, the end-of-life phase is managed predominantly by general practitioners and specialists in palliative care. Close cooperation between these specialties is necessary to meet the specific needs of glioma patients.

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