Abstract Details

Title Use of medical assistance in dying (“Death with Dignity”) in Washington state patients with brain tumors.

Topic Neuro-oncology

Presentation(s) Neuro-oncology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 007

Objective Describe brain tumor patients in Washington state who request medical assistance in dying (MAiD) and compare to other diagnoses.

Background Over 200 people annually utilize the “Death with Dignity” (DWD) process in Washington for MAiD. Other papers have described use of DWD in Washington for cancer or amyotrophic lateral sclerosis (ALS), but not brain tumors.

Design/Methods IRB-approved retrospective chart review.

Results Twenty brain tumor patients accessed DWD since 2015. Median age at death was 51 (range 38-79) and 75% were men. Ten glioblastomas (50%), anaplastic glioma 8 (40%), one grade 2 astrocytoma and one presumed high grade glioma by imaging. Median Karnofsky Performance Status (KPS) was 90 at diagnosis (range 50-100) and 70 at DWD request (range 40-90). Standard radiation and chemotherapy had been taken by 17 (85%) before they requested DWD, while 3 (15%, ages 70-79, KPS 50-90) requested DWD immediately after diagnosis and did not have radiation or chemotherapy. Pain was noted at time of DWD request in 4 patients (20%), only 2 using opioids (10%). Six patients (30%) continued active tumor directed therapy (mostly bevacizumab) after obtaining approval for DWD. Median OS of patients requesting DWD was 22 months from diagnosis (range 2-285 months) in the whole cohort, and 24 months, excluding patients who declined initial chemoradiation (range 8-285 months). Compared to published cancer and ALS cohorts from our institution, brain tumor patients were more likely to request DWD due to concerns of being a burden to others (vs cancer and ALS), more likely to request DWD due to concerns about loss of bodily control (>cancer, = ALS), and more likely than ALS to request DWD due to concerns about pain (but similar to cancer patients).

Conclusions

Most brain tumor patients in our cohort requested DWD after undergoing chemoradiation, pain was uncommon, and survival from diagnosis was comparable to standard therapy.

Authors/Disclosures
Jerome J. Graber, MD, MPH, FAAN (University of Washington) PRESENTER	Dr. Graber has received personal compensation for serving as an employee of Binaytara Foundation. Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ��ɫ��. Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Dickie McCamey Attorneys at Law. Dr. Graber has a non-compensated relationship as a Editorial Board member with Neuro-Oncology: Practice, published by Oxford that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Journal of Pain and Symptom Management that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors and Certification Exam Committee Member with United Council of Neurological Subspecialties that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Question of the Day 'app' committee and NeuroSAE and Continuum with ��ɫ�� that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Practical Neurology (BMC) that is relevant to AAN interests or activities.
	No disclosure on file
Lynne P. Taylor, MD, FAAN (University of Washington)	Dr. Taylor has received publishing royalties from a publication relating to health care.

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