End-of-life Challenges in Neuro-oncological Patient Care: A Survey from the Junge Neuroonkologische Arbeitsgemeinschaft

Background Malignant brain tumors inevitably recur, leading to progressive neurological decline. Palliative care is essential for optimizing patient outcomes, yet its integration into neuro-oncology remains inconsistent. We conducted a nationwide survey to evaluate palliative care practices among German neuro-oncologists and assessed the impact of physicians’ comfort on end-of-life discussions in patient care. Methods A nationwide, anonymous survey was distributed to 481 neuro-oncologists who are members of the Neuro-oncology Working Group of the German Cancer Society. The questionnaire, developed in collaboration with board-certified palliative care specialists, evaluated physicians’ demographic characteristics, palliative care knowledge, and access to palliative care resources. Results Of 92 respondents (survey response rate: 92/481 - 19%), 81 (88%) reported comfort in discussing end-of-life issues, while 11 (12%) expressed discomfort. Physicians comfortable with these discussions more frequently addressed withholding of life-sustaining interventions (88% versus 55%), arranged home care (81% versus 64%), and facilitated hospice placement (68% versus 36%). They also initiated these conversations earlier and observed greater patient receptivity to palliative care. Conclusions While most neuro-oncologists report comfort with end-of-life discussions, this comfort was associated with differences in timing and extent of palliative care integration. Our findings highlight the need for structured palliative care training to ensure timely and effective discussions, ultimately improving care for neuro-oncological patients.