BNOS 2022: Where do people with primary malignant brain tumour die?

 

At the end of June 2022, I had the chance to present my work at the British Neuro-Oncology Society (BNOS) Conference, in partnership with the Computational Oncology Laboratory. Now that I am back from Liverpool, where the conference took place, I thought to write quick a summary of my analysis on the end-of-life care for patients diagnosed with a primary brain tumour in England between 2013 and 2018.

Every year, 12,000 new cases of brain tumours are diagnosed in the UK, making brain tumours the 9th most common cancer. Prognosis is often inauspicious, with only 12% of patients surviving 5 years or more.

Research on end-of-life care is rare and the national picture is even rarer. We know that usually people with cancer prefer to die at home, although this is not always the case, and a high number of patients continue to die in hospital or hospices. We are interested in understanding what factors affect the location of death and if having treatment within a few months before death affect the location of death.

We have data of 50,000+ adults diagnosed with a primary brain tumour between 2013 and 2018 in England. From this cohort, we selected 20,670 patients who died, of whom, 36% died at home, 52% died somewhere outside their private home and 12% had an unknown location of death.

We first looked at what treatment patients had and where they died. Overall, 47% (n = 9,682) patients had radiotherapy, 29% (n = 5,947) had chemotherapy, and 87% (n = 18,013) patients underwent surgery. However, in the 3 months before death, these rates drop to 8.7% (n = 1,806) for radiotherapy, 6% (n = 1,292) for chemotherapy and 6% (n = 7,370) for surgery.

Although a third of our patients died at home, this rate decreases when the treatment is administered within 3 months before death (33% for radiotherapy, 32% for chemotherapy and 27% for patients that had surgery).

Preliminary results also showed that:

a higher percentage of female (42%) died at home compared to men (40%), patients diagnosed with a glioblastoma were more likely to die at home compared with the other malignant diagnoses (42% and 39% respectively).

The results also highlighted regional differences: West Midlands has the lowest percentage of patients dying at home (34%), followed by London (37%). Whereas North east has the highest percentage (45%) followed by South west (44%). Age also had an impact on the like hood of dying at home with older people more likely to die at home.

Results show that there are several factors that affect the location of death, although it is worth noticing that numbers vary for each group such as region or sex. In addition, we do not have data about patients’ preference, therefore no analysis can be run on an individual level.

I am now running more analysis getting more insights about the location of death and I am also finishing to write these results in a scientific paper format.

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