{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:31:13Z","timestamp":1791855073904,"version":"4.3.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007797","name":"University of Helsinki","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007797","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Palliative care (PC) remains underutilized among patients with primary brain tumors, despite the life-threatening nature of the disease and the high symptom burden. This study aimed to assess how the timing of a PC decision (i.e., terminate life-prolonging anticancer treatments) is associated with emergency department visits and hospitalizations at the end of life (EOL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study included adult patients (\u2265\u200918 years) with primary brain tumor treated at the Comprehensive Cancer Center of Helsinki University Hospital during 2017\u20132018 who died by the end of 2018. Patients were categorized into \u201cearly PC decision\u201d (&gt;\u200930 days before death) or \u201clate\/no PC decision\u201d (\u2264\u200930 days or no decision). We extracted data on hospital resource use from electronic medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 162 patients (mean age 66 years, range 24\u201397; 57% male), 64% had a documented PC decision, with 43% of the total cohort having an early PC decision. Patients with an early PC decision had significantly fewer emergency department visits (10% vs. 25%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015) and fewer hospitalizations (4% vs. 29%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in their final month of life compared to those with a late\/no decision. Overall, 34% of patients visited a dedicated PC unit, with a median of 93 days (range 5-619) from the first PC unit visit to death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An early PC decision significantly reduced acute hospital resource use at EOL among brain tumor patients. Nonetheless, approximately one-third of patients had no documented PC decision, and similarly low numbers had PC unit visits, highlighting ongoing gaps in timely PC initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-025-05377-3","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:44:58Z","timestamp":1766573098000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Early palliative care decision in patients with primary brain tumor reduces emergency department visits and hospitalization at the end of life"],"prefix":"10.1007","volume":"176","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0973-9161","authenticated-orcid":false,"given":"Nelli-Sofia","family":"N\u00e5hls","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu","family":"Anttonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauliina","family":"Kitti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riikka-Leena","family":"Leskel\u00e4","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Outi","family":"Akr\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiina","family":"Saarto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Carp\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"issue":"6","key":"5377_CR1","doi-asserted-by":"publisher","first-page":"e330","DOI":"10.1016\/S1470-2045(17)30345-5","volume":"18","author":"A Pace","year":"2017","unstructured":"Pace A, Dirven L, Koekkoek JAF et al (2017) European association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma. 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No human interventions were involved, and all data were anonymized prior to analysis. According to Finnish legislation, no ethical approval is needed in retrospective registry studies (Act on the Secondary Use of Social and Health Information 522\/2019). Authorities of Helsinki University Hospital have approved the study protocol (HUS\/325\/2023) and waived the need for ethical approval and for informed consents based on the legislation of retrospective register-based studies (522\/2019). We confirm that all methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"137"}}