Patterns of Care for Adults With Malignant GliomaPatterns of Care for Adults With Malignant Glioma

To the Editor: In their analysis of the patterns of care for adults with newly diagnosed malignant glioma enrolled in the Glioma Outcomes Project,¹ Dr Chang and colleagues concluded that practice patterns may at times conflict with current literature (eg, infrequent use of chemotherapy) or contradict accepted guidelines (88% of patients received prescription of antiepileptic drugs, with only 32% reporting seizures). In an editorial in the same issue, Drs Fisher and Buffler² question whether the current state of treatment for these patients approaches “therapeutic nihilism.” The unmet medical needs of these patients are clearly illustrated by the finding that 28.5% of the patients used some form of alternative medicine. This is hardly surprising, since no significant difference in survival was found between those participants enrolled in formal clinical trials and those participating in alternative therapies.

With such a consistently poor prognosis for malignant gliomas, what is most striking is the absence of discussion of the appropriateness of palliative care for this patient population. Given their short life expectancy, it is axiomatic that these patients be offered palliative care at the time of diagnosis. Palliative medicine, an emerging specialty, extends the principles of hospice—focused on care delivery for patients near the end of life—“upstream” in the disease process, benefiting a wider population at an earlier point in the disease process. This broader view of palliative medicine accepts that some therapies—in this case radiation, chemotherapy, antidepressants, or heparin—may be appropriate even though the disease ultimately will prove fatal.