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Jiramongkolchai P, Vacaru A, La Monte O, Lee J, Schwartz MS, Friedman RA. Quality of Life for Patients with Sporadic Small Vestibular Schwannomas Following Middle Fossa Craniotomy. Otol Neurotol 2024; 45:684-689. [PMID: 38769097 DOI: 10.1097/mao.0000000000004202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To evaluate quality-of-life outcomes for patients with vestibular schwannomas (VS) undergoing a middle cranial fossa (MCF) approach. STUDY DESIGN Prospective study from 2018 to 2023. SETTING Tertiary academic institution. PATIENTS Adults with sporadic VS. INTERVENTIONS MCF. MAIN OUTCOME MEASURES The primary outcome measure was the change in preoperative and 1-year postoperative Penn Acoustic Neuroma Quality-of-life (PANQOL) scores. Secondary outcome measures included hearing preservation and facial nerve function. RESULTS Of the 164 patients who underwent MCF for sporadic VS, 78 patients elected to voluntarily complete preoperative PANQOL assessments prior to surgery. Seventy-one (91%) of those 78 patients completed postoperative PANQOL surveys. Fifty (70%) of the respondents were female and the median age was 48 years (range, 27-71 years). Overall, at 1-year postsurgery, a minimal clinically important difference (MCID) was obtained in the hearing (mean difference, 10.5; 95% confidence interval [CI], 4.3-16.7) and anxiety (mean difference, 18.8; 95% CI, 11.7-25.9) domains. For patients with hearing preservation (n = 48, 68%), MCIDs were reached in the hearing (mean difference, 13.4; 95% CI, 6.3-20.6), anxiety (mean difference, 20.8; 95% CI, 11.8-29.9), energy (mean difference, 13.7; 95% CI, 3.6-23.8), pain (mean difference, 13.7; 95% CI, 3.6-23.8) domains, and overall PANQOL scores (mean difference, 12.7; 95% CI, 7.1-18.3). Postoperatively, 64 (90%) patients maintained a House-Brackmann I. CONCLUSIONS To our knowledge, this is the largest study examining disease-specific QOL for VS patients undergoing MCF. Based on our institution's experience, MCF approach for small VS is associated with clinically meaningful improvements in QOL, hearing preservation, and excellent facial nerve outcomes.
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Affiliation(s)
| | | | | | - Joshua Lee
- Department of Otolaryngology-Head and Neck Surgery
| | - Marc S Schwartz
- Department of Neurosurgical Surgery, University of California, San Diego, La Jolla, California
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Nowacka A, Barker-Collo S, Miles A. Exploring the influence of appearance evaluation apprehension: How fear of negative evaluation affects quality of life in people with Vestibular Schwannoma. J Clin Neurosci 2024; 123:7-12. [PMID: 38508019 DOI: 10.1016/j.jocn.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
People diagnosed with Vestibular Schwannoma (VS) can experience several symptoms both pre and post-treatment. These, alongside the diagnosis experience, can significantly impact their daily life. The present research is a continuation of a larger study aiming to explore the impacts of symptomology and body image/fear of negative evaluation (FNAE) on the quality of life (QOL) for people with VS. The research design was exploratory and involved a nationwide survey with a total of 52 participants. FNAE was assessed using a measurement of the same name, and QOL was assessed using the Penn Acoustic Neuroma Quality of Life scale (PANQOL). Comparing management groups revealed a significant difference in FNAE with higher scores for surgery compared to radiation treatment. Regression analyses revealed that FNAE significantly accounted for 10.9% of the variance in QOL. However, no symptom was significantly predictive of FNAE. In conclusion, VS is associated with several symptoms that can persist post-treatment. Body satisfaction contributes to QOL and may differ between management types. However, due to inconclusive findings on the predictability of symptoms on FNAE, other moderator factors could influence these direct relationships. Future studies should evaluate the variables that could mitigate or protect from the impacts of FNAE for this population.
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Affiliation(s)
- Alicja Nowacka
- School of Psychology, The University of Auckland, Auckland, New Zealand.
| | - Suzanne Barker-Collo
- Clinical Training Programme, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
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Ben-Harosh L, Barker-Collo S, Nowacka A, Garrett J, Miles A. Quality of life and broader experiences of those with acoustic neuroma: a mixed methods approach. BRAIN IMPAIR 2024; 25:IB23072. [PMID: 38566292 DOI: 10.1071/ib23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 04/04/2024]
Abstract
Background Acoustic neuromas (ANs) are consistently associated with decreased quality of life (QOL) related to the physical and psychosocial impacts of symptoms experienced from the tumour and its treatment. This study explored patient-reported experiences of ANs in New Zealand, with a focus on the impact on QOL and the provision of information, support and services. Methods A mixed methods approach was taken, conducting an online community survey that included the Penn Acoustic Neuroma Quality of Life Scale (N = 52). Those who indicated interest were offered semi-structured interviews after the survey (N = 17), which were analysed using content analysis. Results A negative impact on QOL was found, highlighting five key themes in the experiences of people: (1) ongoing physical, social and psychological impacts; (2) information and support from the medical system; (3) autonomy and decision-making; (4) the importance of peer support; and (5) remaining positive - life goes on. Conclusions Our findings indicate areas for improvement that may benefit people's healthcare experience and QOL. Both quantitative and qualitative results identified gaps associated with person-centred care and the need for information, education, emotional support and access to services. Recommendations include a need for more information (verbal and written) during all stages of diagnosis and treatment, shared decision-making and increased access to allied health, including psychological services and support groups.
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Affiliation(s)
- Lior Ben-Harosh
- School of Psychology, The University of Auckland, New Zealand
| | | | - Alicja Nowacka
- School of Psychology, The University of Auckland, New Zealand
| | - Joanne Garrett
- School of Psychology, The University of Auckland, New Zealand
| | - Anna Miles
- School of Psychology, The University of Auckland, New Zealand
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Nowacka A, Barker-Collo S, Miles A, Ben-Harosh L. The effect of symptomatology and mental wellbeing on quality of life in people with acoustic neuroma. J Clin Neurosci 2023; 116:1-7. [PMID: 37597328 DOI: 10.1016/j.jocn.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Acoustic neuroma (AN) research largely employs a medical framework to understand health outcomes. An alternative is to examine quality of life (QOL) outcomes. This study explored whether mental well-being (i.e., anxiety and depression) were predictive of QOL in those with AN over and above symptomatology. METHODS A nationwide online survey was distributed to 24 community organisations. The inclusion criteria were a diagnosis of AN irrespective of the treatment approach. There were 52 respondents. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using Penn Acoustic Neuroma QOL scale (PANQOL). RESULTS The most frequently reported symptoms reported were poor balance, tinnitus, hearing loss, and headache. Preliminary analyses suggested that headaches, tinnitus and mental well-being were significantly correlated with QOL. Hierarchical regression revealed that these two symptoms and mental well-being accounted for 18.7% and 51.1% of the variance in QOL, respectively. In addition, there was a significant difference in depression scores between management types, with the surgery group having a significantly higher depression score than the radiation group. CONCLUSION Symptoms and mood contribute to QOL for those diagnosed with AN. This can be understood through the common-sense model and fear of cancer recurrence. Screening for psychological difficulties should be provided from the point of diagnosis to post-treatment to allow for targeted management plans to mitigate the effects of these on QOL.
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Affiliation(s)
- Alicja Nowacka
- School of Psychology, The University of Auckland, Auckland, New Zealand.
| | - Suzanne Barker-Collo
- Clinical Training Programme, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Lior Ben-Harosh
- School of Psychology, The University of Auckland, Auckland, New Zealand
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Neve OM, Jansen JC, Koot RW, Ridder MD, Paul G van Benthem P, Stiggelbout AM, Hensen EF. Long-Term Quality of Life of Vestibular Schwannoma Patients: A Longitudinal Analysis. Otolaryngol Head Neck Surg 2023; 168:210-217. [PMID: 35349360 DOI: 10.1177/01945998221088565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Vestibular schwannoma management aims to maintain optimal quality of life (QoL) while preventing severe sequelae of the tumor or its treatment. This study assessed long-term QoL of patients with vestibular schwannoma in relation to treatment modality and decisional regret. STUDY DESIGN A longitudinal study, in which clinical and QoL data were used that were cross-sectionally acquired in 2014 and again in 2020 from the same patient group. SETTING A tertiary expert center for vestibular schwannoma care in the Netherlands. METHODS QoL was measured by the Penn Acoustic Quality of Life (PANQOL) scale. Changes in time were assed using a linear mixed model. In addition, the Decision Regret Scale was analyzed. RESULTS Of 867 patients, 536 responded (62%), with a median follow-up of 11 years. All PANQOL subdomain scores remained stable over time and did not exceed minimal clinically important difference (MCID) levels. Time since treatment did not affect QoL. Patients had comparable average QoL scores and proportions of patients with changing QoL scores (ie, exceeding the MCID) over time, irrespective of the received initial treatment. Female patients and those who required salvage therapy (either by radiotherapy or surgery) reported a lower QoL. The latter patient group reported the highest decisional regret. CONCLUSION On average, the long-term QoL of patients with vestibular schwannoma is comparable for patients under active surveillance and those who have received active treatment, and it remains stable over time. This suggests that, on average, preservation of QoL of patients with vestibular schwannoma is feasible when adequately managed.
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Affiliation(s)
- Olaf M Neve
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Radboud W Koot
- Department of Neurosurgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Mischa de Ridder
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
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Adegboyega G, Jordan C, Kawka M, Chisvo N, Toescu SM, Hill C. Quality of life reporting in the management of posterior fossa tumours: A systematic review. Front Surg 2022; 9:970889. [PMID: 36303860 PMCID: PMC9594859 DOI: 10.3389/fsurg.2022.970889] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Survival amongst posterior fossa tumour (PFT) patients is improving. Clinical endpoints such as overall survival fail to depict QoL. There is yet to be a review of current QoL instruments used for adult PFTs. Aim of this review is to outline the QoL reporting in the management of PFTs and measure participation level. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A search strategy to identify adult patients with PFTs who took part in QoL metrics was conducted. Observational and experimental studies published from 1990 to date were included. Studies with a sample size less than 10 and performance measures such as Karnofsky Performance Status were not considered. Results A total of 116 studies were included in the final analysis. Vestibular schwannomas were the most common tumour pathology (n = 23,886, 92.6%) followed by pilocytic astrocytomas (n = 657, 2.5%) and meningiomas (n = 437, 1.7%) Twenty-five different QoL measures were used in the study pool. SF-36 was the most common (n = 55, 17 47.4%) QoL metric in the whole study pool, followed by the Penn Acoustic Neuroma QoL scale (n = 24, 20.7%) and Dizziness Handicap Inventory (n = 16, 13.8%). Seventy-two studies reported less-than 100% participation in QoL evaluation. The commonest reason for non-participation was a lack of response (n = 1,718, 60.8%), incomplete questionnaires (n = 268, 9.4%) and cognitive dysfunction (n = 258, 9.1%). Conclusion Informed clinical decision-making in PFT patients requires the development of specific QoL outcomes. Core outcome sets, and minimal clinically important differences (MCID) are essential for these metrics to show clinically significant improvements in patient QoL.
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Affiliation(s)
- Gideon Adegboyega
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Chloe Jordan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Michal Kawka
- Imperial College London School of Medicine, London, United Kingdom
| | - Nathan Chisvo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Ciaran Hill
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- University College London Cancer Institute, London, United Kingdom
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Quality of life in patients of unilateral vestibular schwannoma treated with microsurgery: A South-Asian tertiary care Hospital experience. J Clin Neurosci 2021; 89:264-270. [PMID: 34119279 DOI: 10.1016/j.jocn.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
Majority of the published literature on the impact of microsurgery over quality-of-life (QOL) in vestibular schwannoma (VS) patients is retrospective in nature, with variable results, and there has been very little contribution from South-Asia. The authors designed this study to investigate the role of microsurgery in QOL alterations in VS patients, and to compare obtained QOL scores with that of control population. Between February 2017 and March 2018, a prospective/retrospective study was done at our institute. Prospective and retrospective cohorts included, 30 and 34 consecutive patients, respectively, of unilateral VS undergoing microsurgery. QOL assessment was done using Short Form-36 (SF-36), and the Penn Acoustic Neuroma Quality-Of-Life (PANQOL) questionnaires. Prospective cohort underwent QOL assessment at 3 junctures - pre-surgery, 3-months & 1-year post-surgery; while retrospective cohort was assessed only once, at 1-year post-surgery. Age- & sex- matched normal population and diabetic patients were used as controls. In the prospective cohort, patients showed drop in all PANQOL domain/ SF-36 dimension scores at 3-month post-surgery, exception being vitality and general health in SF-36; showed improvement at 1-year follow-up, with majority either levelling or improving their respective pre-surgery scores. Gross total resection, tumors ≤ 3 cm, and age ≤ 45 years had better PANQOL scores at 1-year post-surgery across all the domains. Patients in both the cohorts showed worse QOL compared to normal population, but the gap got narrower at 1-year post-surgery. Our study adds a South-Asian perspective to the pool of prospective knowledge available on QOL following microsurgery in VS patients.
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Chweya CM, Tombers NM, Lohse CM, Link MJ, Carlson ML. Disease-Specific Quality of Life in Vestibular Schwannoma: A National Cross-sectional Study Comparing Microsurgery, Radiosurgery, and Observation. Otolaryngol Head Neck Surg 2020; 164:639-644. [PMID: 32689889 DOI: 10.1177/0194599820941012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the impact of treatment on disease-specific health-related quality of life (HRQOL) among patients with sporadic vestibular schwannoma (VS). STUDY DESIGN National cross-sectional study. SETTING Tertiary referral center and the Acoustic Neuroma Association. SUBJECTS AND METHODS Adult patients with VS who completed the Penn Acoustic Neuroma Quality of Life (PANQOL) survey. Patients were classified by treatment at the most recent survey as microsurgery, radiosurgery, observation, or recently diagnosed (RD). PANQOL scores were compared among VS treatment groups and with nontumor controls using analysis of covariance. RESULTS A total of 1362 respondents with VS were analyzed. Total PANQOL scores differed significantly by treatment (P = .024) with adjusted means of 60, 63, 65, and 62 for the microsurgery, radiosurgery, observation, and RD groups, respectively. Subdomain scores for facial function, balance, hearing loss, and pain differed significantly (P < .05) by treatment. Comparisons that surpassed thresholds for clinical significance included microsurgery compared to radiosurgery and observation for facial function, microsurgery compared to observation and RD for hearing loss, and microsurgery compared to radiosurgery and observation for pain. Subdomain scores for anxiety, facial function, balance, hearing loss, energy, and pain and total PANQOL scores for nontumor controls were significantly higher (ie, more favorable) compared to the VS groups (P < .05). General health scores did not differ significantly between the nontumor controls and the VS groups (P = .19). CONCLUSION Differences in HRQOL among treatment modalities are small and variably exceed the minimal clinically important difference. The impact of a VS diagnosis on HRQOL supersedes that of the treatment type.
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Affiliation(s)
- Cynthia M Chweya
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole M Tombers
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Nishiyama T, Oishi N, Kojima T, Kasuya K, Noguchi M, Ishikawa T, Hosoya M, Ogawa K. Validation and multidimensional analysis of the japanese penn acoustic neuroma quality‐of‐life scale. Laryngoscope 2020; 130:2885-2890. [DOI: 10.1002/lary.28488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Takanori Nishiyama
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Naoki Oishi
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Takashi Kojima
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Kento Kasuya
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Masaru Noguchi
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Toru Ishikawa
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Makoto Hosoya
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
| | - Kaoru Ogawa
- Department of Otolaryngology‐Head and Neck Surgery Keio University School of Medicine Tokyo Japan
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Factors Associated With Facial Nerve Paresis Following Gamma Knife for Vestibular Schwannoma. Otol Neurotol 2020; 41:e83-e88. [DOI: 10.1097/mao.0000000000002401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Differentiating the General Vestibular Schwannoma Patient Population, Tertiary Referral Center Cohorts, and the Acoustic Neuroma Association Survey Respondents: A Response to the Benefits and Drawbacks of Survey-Based Studies. Otol Neurotol 2019; 40:980-982. [DOI: 10.1097/mao.0000000000002308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Influence of Selection Bias in Survey Studies Derived From a Patient-Focused Organization: A Comparison of Response Data From a Single Tertiary Care Center and the Acoustic Neuroma Association. Otol Neurotol 2019; 40:504-510. [DOI: 10.1097/mao.0000000000002151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acoustic neuroma quality of life: are we missing the point? Eur Arch Otorhinolaryngol 2018; 276:1549-1550. [DOI: 10.1007/s00405-018-5037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
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