Potentially inappropriate care at the end of life in patients with glioblastoma: A single-center observational cohort study.

BACKGROUND: Timely integration of palliative care is critical in the management of patients with glioblastoma. This study evaluated the frequency and determinants of potentially inappropriate care in the final 3 months of life on population level. METHODS: Patient characteristics and healthcare utilization were extracted from medical records for deceased patients diagnosed with glioblastoma, who survived at least 3 months after diagnosis and received routine care at a single tertiary hospital between January 2015 and February 2026. Potentially inappropriate care was defined as the proportion of patients with any of these indicators in the final 3 months of life: ≥2 emergency department visits, ≥2 hospital admissions, >14 consecutive hospitalization days, intensive care unit admission, chemotherapy administration, or in-hospital death. Logistic regression analyses were performed to identify factors associated with receiving potentially inappropriate care. RESULTS: The cohort included 310 patients (median age 66 [IQR 56-72], 60% male), of whom 22% (n = 67/310) received potentially inappropriate care in the final 3 months of life. Chemotherapy was the main driver (n = 58/67, 87%), followed by ≥2 hospital admissions (n = 10/67, 15%) and in-hospital death (n = 9/67, 13%). Older patients (OR 0.97, 95% CI, 0.94-0.99) or those with an unmethylated O6-methylguanine-DNA methyltransferase (MGMT) promoter (OR 0.42, 95% CI, 0.23-0.75) were less likely to receive potentially inappropriate care. CONCLUSION: One in 5 patients with glioblastoma received potentially inappropriate care at the end of life, predominantly through chemotherapy. Younger patients and those with methylated MGMT promoters were most affected. Identification of patients at risk may support targeted palliative care interventions.