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Schellack S, Breidenbach C, Rick O, Kowalski C. Predictive factors for return to work among cancer survivors in Europe: A systematic review. Crit Rev Oncol Hematol 2024; 200:104422. [PMID: 38897312 DOI: 10.1016/j.critrevonc.2024.104422] [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: 02/06/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
Of the 4.4 million people diagnosed with cancer in Europe each year, around 36 % are of working age. Return-to-work rates vary across Europe. Work is important for the individual, as well as for society, and this review aims to provide an overview of the predictors for the return to work (RTW) process in European cancer survivors of working age. A systematic literature search was conducted. The present review included quantitative and qualitative study designs published since 2013. In total, the review included 85 papers examining cancer survivors with various cancer diagnoses in 18 European countries. Identified predictive factors for RTW related to the social system, treatment, disease, health behavior, the individuals' psychosocial, work, and sociodemographic situations. There is a need for a standardized definition and operationalization of RTW. Providers can use these results to identify survivors at risk and support cancer survivors in their RTW process.
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Affiliation(s)
- Sophie Schellack
- German Cancer Society, Kuno-Fischer-Straße 8, Berlin 14057, Germany.
| | | | - Oliver Rick
- Center for Oncology Rehabilitation, Clinic Reinhardshoehe, Quellenstraße 8-12, Bad Wildungen 34537, Germany
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Breidenbach C, Ernstmann N, Schellack S, Degenhardt M, Heidkamp P, Heier L, Hiltrop K, Rick O, Soff J, Kowalski C. [Return to Work after Cancer - a Systematic Review of Predictors in Germany]. DIE REHABILITATION 2024. [PMID: 38917850 DOI: 10.1055/a-2300-3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
INTRODUCTION More than one third of cancer survivors are of working age. Return to work (RTW) with and after cancer treatment is therefore an important issue for this group - but this is often accompanied with many challenges. The aim of this systematic review was to identify predictors of RTW after cancer from the literature specifically for Germany and to place these factors chronologically in the oncological course of treatment. METHODS A systematic search was performed using PubMed in June 2022. Included were all papers original published in German or English between 2000 and 2022 and referring to a German sample, regardless of study design. RESULTS From a total of 8,381 hits in the meta-database, 30 publications were finally considered in the synthesis of results. Higher age, lower education, lower socioeconomic status, higher disease stage, more progressive disease course, more severe side effects of treatment, (more severe) fatigue, higher psychological distress, worse health status, occupational status as a blue collar worker and manual labor, unemployment prior to diagnosis, more negative perceptions of the work(place) environment, and lower intention to work and lower work ability/ subjective prognosis of employability were associated with lower likelihood of RTW after cancer in the literature. Treatment type and use of rehabilitation were also found to be associated with RTW. DISCUSSION Sociodemographic, disease-related, psychosocial, and work-related predictors of RTW after cancer in Germany were identified. The results may help to develop targeted support measures that can be applied in specific phases of treatment. The comparability of the literature on predictors for RTW is limited due to a high heterogeneity in the operationalization of RTW and methodological approaches. There is need for further standardization in this area.
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Affiliation(s)
- Clara Breidenbach
- Deutsche Krebsgesellschaft eV, Berlin
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Lehrstuhl für Versorgungsforschung, Köln
| | - Nicole Ernstmann
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Lehrstuhl für Versorgungsforschung, Köln
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Uniklinik Bonn
| | | | - Marie Degenhardt
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Uniklinik Bonn
| | - Paula Heidkamp
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Uniklinik Bonn
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Lehrstuhl für Versorgungsforschung, Köln
| | - Lina Heier
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Uniklinik Bonn
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Lehrstuhl für Versorgungsforschung, Köln
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Kati Hiltrop
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Lehrstuhl für Versorgungsforschung, Köln
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Uniklinik Bonn
| | - Oliver Rick
- Fachklinik für onkologische Rehabilitation, Klinik Reinhardshöhe, Bad Wildungen
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Barberis M, Poisson I, Prévost-Tarabon C, Letrange S, Froelich S, Thirion B, Mandonnet E. Verbal fluency predicts work resumption after awake surgery in low-grade glioma patients. Acta Neurochir (Wien) 2024; 166:88. [PMID: 38372820 DOI: 10.1007/s00701-024-05971-w] [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: 10/03/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Resuming professional activity after awake surgery for diffuse low-grade glioma (DLGG) is an important goal, which is not reached in every patient. Cognitive deficits can occur and persist after surgery. In this study, we analyzed the impact of mild cognitive impairments on the work resumption. METHODS Fifty-four surgeries (including five redo surgeries) performed between 2012 and 2020 for grade 2 (45) and 3 (nine) DLGG in 49 professionally active patients (mean age 40 [range 23-58.) were included. We retrospectively extracted the results of semantic and phonemic verbal fluency tests from preoperative and 4-month postoperative cognitive assessments. Patients were interviewed about their working life after surgery, between April and June 2021. RESULTS Patients (85%) returned to work, most within 3 to 6 months. Patients (76%) reported subjective complaints (primarily fatigue). Self-reported symptoms and individual and clinical variables had no impact on the work resumption. Late-postoperative average Z-scores in verbal fluency tasks were significantly lower than preoperative for the entire cohort (Wilcoxon test, p < 0.001 for semantic and p = 0.008 for phonemic fluency). The decrease in Z-scores was significantly greater (Mann Whitney U-test, semantic, p = 0.018; phonemic, p = 0.004) in the group of patients who did not return to work than in the group of patients who did. CONCLUSION The proportion of patients returning to work was comparable to similar studies. A decrease in verbal fluency tasks could predict the inability to return to work.
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Affiliation(s)
- Marion Barberis
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France.
- UMR 7225, Frontlab, Paris Brain Institute, CNRS, INSERM U1127, 75013, Paris, France.
| | - Isabelle Poisson
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
| | | | - Sophie Letrange
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
| | - Sébastien Froelich
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
- Université de Paris Cité, 75010, Paris, France
| | | | - Emmanuel Mandonnet
- Neurosurgery Unit, Hôpital Lariboisière, AP-HP, 75010, Paris, France
- Université de Paris Cité, 75010, Paris, France
- UMR 7225, Frontlab, Paris Brain Institute, CNRS, INSERM U1127, 75013, Paris, France
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Nicklin E, Phang I, Short SC, Hoogendoorn P, Boele FW. Patient and caregiver return to work after a primary brain tumor. Neurooncol Pract 2023; 10:565-575. [PMID: 38026585 PMCID: PMC10666801 DOI: 10.1093/nop/npad039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background Studies focusing on the return to work (RTW) experiences of patients with a brain tumor (BT) are scarce. We aimed to explore, in-depth, the occupational expectations, experiences, and satisfaction of patients who RTW after a BT diagnosis and treatment, those not able to, and their family caregivers. Methods This multicenter, cross-sectional study utilized semi-structured interviews and reflexive thematic analysis. Interviews were conducted with adults diagnosed with primary BT, in employment/self-employed before diagnosis, currently in follow-up care, and also with their caregivers. Results In total, 23 interviews (17 patients/6 caregivers) took place. Five themes were developed: (1) Early (adjustments and) expectations: "Thought I would be back at work the following Monday"; pre-treatment patients wanted to be better informed about potential recovery time and side-effects. (2) Drivers to RTW: "Getting my life back on track"; RTW was seen as a symbol of normality and also dictated by financial pressures. (3) Experiences returning to work: "It's had its ups and downs": patients who had successfully returned were supported by employers financially, emotionally, and practically. (4) Required support: "He had surgery and that was it": suggested support included a back-to-work scheme and comprehensive financial support. (5) Caring and paid work: The "juggling act": carer's work was significantly impacted; often reducing/increasing their working hours while managing increasing caring demands. Conclusions Future research focusing on RTW in neuro-oncology populations is needed. Interventions should be developed to improve employer/employee communication, and increase knowledge about BT care and possibilities for RTW, to support patients and caregivers towards sustained employment.
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Affiliation(s)
- Emma Nicklin
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
| | - Isaac Phang
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Susan C Short
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
| | | | - Florien W Boele
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Kamson DO, Puri S, Sang Y, Shi MJ, Blair L, Blakeley JO, Laterra J. Impact of Frontline Ivosidenib on Volumetric Growth Patterns in Isocitrate Dehydrogenase-mutant Astrocytic and Oligodendroglial Tumors. Clin Cancer Res 2023; 29:4863-4869. [PMID: 37382607 PMCID: PMC10756070 DOI: 10.1158/1078-0432.ccr-23-0585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/01/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Isocitrate dehydrogenase (IDH)-mutant gliomas are usually treated with radiotherapy and chemotherapy, which increases the risk for neurocognitive sequelae during patients' most productive years. We report our experience using off-label first-in-class mutant IDH1 inhibitor ivosidenib and its impact on tumor volume in IDH-mutant gliomas. EXPERIMENTAL DESIGN We retrospectively analyzed patients ages ≥18 years with radiation/chemotherapy-naïve, mutant IDH1, nonenhancing, radiographically active, grade 2/3 gliomas, and ≥2 pretreatment and ≥2 on-treatment ivosidenib MRIs. T2/FLAIR-based tumor volumes, growth rates, and progression-free survival (PFS) were analyzed. log-linear mixed-effect modeling of growth curves adjusted for grade, histology, and age was performed. RESULTS We analyzed 116 MRIs of 12 patients [10 males, median age 46 years (range: 26-60)]: 8 astrocytomas (50% grade 3) and 4 grade 2 oligodendrogliomas. Median on-drug follow-up was 13.2 months [interquartile range (IQR): 9.7-22.2]. Tolerability was 100%. A total of 50% of patients experienced ≥20% tumor volume reduction on-treatment and absolute growth rate was lower during treatment (-1.2 ± 10.6 cc/year) than before treatment (8.0 ± 7.7 cc/year; P ≤ 0.05). log-linear models in the Stable group (n = 9) showed significant growth before treatment (53%/year; P = 0.013), and volume reduction (-34%/year; P = 0.037) after 5 months on treatment. After treatment, volume curves were significantly lower than before treatment (after/before treatment ratio 0.5; P < 0.01). Median time-to-best response was 11.2 (IQR: 1.7-33.4) months, and 16.8 (IQR: 2.6-33.5) months in patients on drug for ≥1 year. PFS at 9 months was 75%. CONCLUSIONS Ivosidenib was well tolerated and induced a high volumetric response rate. Responders had significant reduction in tumor growth rates and volume reductions observed after a 5-month delay. Thus, ivosidenib appears useful to control tumor growth and delay more toxic therapies in IDH-mutant nonenhancing indolently growing gliomas. See related commentary by Lukas and Horbinski, p. 4709.
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Affiliation(s)
- David Olayinka Kamson
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sushant Puri
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meihui Jessica Shi
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Lindsay Blair
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Jaishri O. Blakeley
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - John Laterra
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Kamp MA, von Sass C, Januzi D, Dibué M, Libourius K, Lawson McLean AC, Baumgarten P, Lawson McLean A, Dinc N, Senft CA. Frequency of social burden and underage children in neuro-oncological patients. J Cancer Res Clin Oncol 2023; 149:15911-15922. [PMID: 37679652 PMCID: PMC10620259 DOI: 10.1007/s00432-023-05338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Brain tumours can cause significant burden for patients and their families, including physical, psychological, and social challenges. This burden can be particularly difficult for patients with malignant brain tumours and those with underage children. However, the frequency of social burden among neuro-oncological patients and the proportion of patients with underaged children is currently unknown. The aim of this retrospective study is to determine the frequency of social and family dysfunction among neuro-oncological patients, the percentage of such patients who have underage children, and to assess their associated burden. METHODS During a 22-month period, all brain tumour patients were asked to complete a short questionnaire that included epidemiological data, the EORTC-qlq-C30 and -BN20 questionnaire, and the distress thermometer. Data were collected and analysed using Prism 9 for macOS (version 9, GraphPad Prism). RESULTS Our analysis included 881 brain tumour patients, of which 540 were female. Median age was 61 years (ranging from 16 to 88 years). Of all patients, 228 suffered from malignant intracranial tumours. More than half of all patients and more than 65% of patients with malignant tumours reported that their illness or medical treatment interfered with their social activities and family life. Almost 30% of patients reported moderate or severe complaints. About 27% of all patients (and 31% of patients with malignancies) expressed moderate or major concerns that their family life could be disrupted. Among the patients with malignancies, 83.5% of patients had a total of 318 children at the time of tumour diagnosis, with a mean age of 33 ± 0.9. Of these patients with malignancies, 38 (17.9%) had a total of 56 underage children at the time of tumour diagnosis, and currently have 53 underage children. Patients with minor children had more financial worries but less interference of their disease with social activities, less psycho-oncological distress, and a more positive outlook into the future (each, p < 0.0001). They evaluated their general health status and quality of life in the week prior to their current appointment significantly better (each p < 0.0001). CONCLUSION Our study found that 17.9% of patients with malignant brain tumours have underage children. However, having underage children may actually be a positive resource for these patients, as they show lower distress values and better quality of life.
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Affiliation(s)
- Marcel A Kamp
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
| | - Christiane von Sass
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Donjetë Januzi
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Maxine Dibué
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Katharina Libourius
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Anna C Lawson McLean
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Peter Baumgarten
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Aaron Lawson McLean
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nazife Dinc
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christian A Senft
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Zegers AD, Coenen P, Heeren A, Takke N, Ardon H, Compter A, Dona D, Kouwenhoven M, Schagen SB, de Vos F, Duijts SFA. Work-related experiences and unmet needs of patients with a malignant glioma and relevant professionals: the BrainWork study. J Cancer Surviv 2023:10.1007/s11764-023-01469-z. [PMID: 37782399 DOI: 10.1007/s11764-023-01469-z] [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: 07/12/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Many patients with a malignant (i.e., grade II-IV) glioma are of working age, yet they are rarely included in "cancer and work" studies. Here, we explored (1) the work-related experiences and unmet needs of patients with a malignant glioma and (2) the experiences and needs of relevant healthcare and occupational (health) professionals ("professionals") in providing work-related support to this patient group. METHODS Individual semi-structured interviews were held with patients with a malignant glioma who were of working age and had an employment contract at diagnosis, and relevant professionals. Interviews were transcribed verbatim and analysed thematically. RESULTS Patients (n = 22) were on average 46 ± 13 years of age (64% male) and diagnosed with a grade II (n = 12), III (n = 4), or IV glioma (n = 6). Professionals (n = 16) had on average 15 ± 9 years of relevant work experience with the patient group. Four themes emerged from the data: (1) having a malignant glioma: experienced consequences on work ability, (2) communicating about the consequences of a malignant glioma at work, (3) distilling the right approach: generic or tailored work-related support, and (4) accessibility of work-related support. CONCLUSIONS Glioma-specific consequences on patients' work ability necessitate better communication between, and tailored guidance for, patients, relevant professionals, and the workplace. Suggestions for improvement, e.g., the periodic use of comprehensive neuropsychological assessments, are provided in the article. IMPLICATIONS FOR CANCER SURVIVORS Patients with a malignant glioma would benefit from tailored and proactive outreach about work-related issues bv relevant professionals.
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Affiliation(s)
- Amber Daniëlle Zegers
- Department of Public and Occupational Health, Amsterdam University Medical Centers Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, Netherlands
- Societal Participation and Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam University Medical Centers Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, Netherlands
- Societal Participation and Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Musculoskeletal Health, Amsterdam Movement Sciences Research Institute, Amsterdam, Netherlands
| | - Amy Heeren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Nadia Takke
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Hilko Ardon
- Department of Neurology, TweeSteden Hospital, Tilburg, Netherlands
| | - Annette Compter
- Department of Neurology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Desiree Dona
- Department of Human Resources, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mathilde Kouwenhoven
- Department of Neurology, Amsterdam University Medical Centers Location Vrije Universiteit, Amsterdam, Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Filip de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam University Medical Centers Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, Netherlands.
- Societal Participation and Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands.
- Department of Medical Psychology, Amsterdam University Medical Centers location Vrije Universiteit, Amsterdam, Netherlands.
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Fauvet C, Villain M, Gatignol P. Repeated awake surgery and quality of life in patients with diffuse glioma: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:156. [PMID: 37382692 DOI: 10.1007/s10143-023-02073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/12/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
Diffuse gliomas significantly affect patients' daily lives. Because of the high risk of recurrence and anaplasic transformation, repeated surgery can be proposed in awake condition to prolongs overall survival by limiting and reducing residual tumour volume. However, oncological interest alone is no longer sufficient due to the consequent increase in median survival, and quality of life is becoming an important issue in clinical decision-making. This systematic review focuses on the effects of repeated surgery in awake condition on the quality of life of adults with diffuse glioma through three parameters: return to work, presence of postoperative neurocognitive disorders, and occurrence of epileptic seizures. A systematic review of the last 20 years was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards. Summarized data from selected studies were processed quantitatively, using a meta-analysis process, with the Review Manager 5.4 software. Five databases (PubMed, Web of Science, Science Direct, Dimensions, and Embase) were used. Fifteen articles were selected for qualitative analysis and 11 for meta-analysis. One hundred and fifty-one patients (85%) returned to an active socio-professional life after repeated surgery, and 78 (41%) presented neurocognitive disorders in the immediate postoperative period, only 3% (n = 4) of them suffering from permanent disorders. One hundred and forty-nine (78%) participants were free of epileptic seizure after repeated surgery. This systematic review of the literature highlights the benefit of repeated surgery on the quality of life of patients with adult diffuse glioma.
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Affiliation(s)
| | - Marie Villain
- AP-HP, Service MPR, Pitié-Salpêtrière University Hospital, Paris, France.
- Speech Therapy Department, Sorbonne Université, Paris, France.
- Sorbonne Université, GRC No. 24, Handicap Moteur Et Cognitif & Réadaptation (HaMCRe) AP-HP, Sorbonne Université, 75013, Paris, France.
| | - Peggy Gatignol
- AP-HP, Service MPR, Pitié-Salpêtrière University Hospital, Paris, France
- Speech Therapy Department, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France
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9
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Lee JA, Kim AR, Tak EY, Kim Y, Shin HJ, Mun GW, Kim SJ, Seol HJ. A single-center prospective study regarding time to return to activities of daily living after craniotomy for brain tumors. Acta Neurochir (Wien) 2023; 165:1389-1400. [PMID: 36977865 PMCID: PMC10047470 DOI: 10.1007/s00701-023-05533-6] [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: 12/10/2022] [Accepted: 02/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND There are few studies on the time to return to activities of daily living (ADL) after craniotomy in patients with brain tumors. This study aimed to investigate the duration before returning to ADLs after craniotomy for brain tumors and present data that can provide information and guidelines on the appropriate time needed. METHODS Patients (n = 183 of 234) who underwent craniotomy for brain tumors between April 2021 and July 2021 capable of self-care upon discharge were enrolled, and data of 158 were collected. The start time of 85 ADL items was prospectively investigated for 4 months postoperatively, using the self-recording sheet. RESULTS Over 89% and 87% of the patients performed basic ADL items within a month and instrumental ADL items within 2 months (medians: within 18 days), except for a few. Regarding work, 50% of the patients returned within 4 months. Washing hair with a wound was performed at 18 days of median value, after 4 months of dyeing/perming hair, 6 days of drinking coffee/tea, after 4 months of air travel, and 40 days of complementary and alternative medicine. In patients with infratentorial tumors or surgical problems, return times were much later for various items. CONCLUSIONS It is possible to provide practical information and guidelines on the duration to return to ADL after craniotomy in brain tumor patients. These study findings also reduce uncertainty about recovery and daily life and help patients return to their daily life at the appropriate time, thereby maintaining function and daily well-being after surgery.
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Affiliation(s)
- Jeong-A Lee
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Ae Ran Kim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Eun-Young Tak
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Yumin Kim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Hyun-Ju Shin
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Gyeong-Won Mun
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Sook-Jin Kim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-Gu, Seoul, 06351, Korea.
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Unemployment Status Subsequent to Cancer Diagnosis and Therapies: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15051513. [PMID: 36900304 PMCID: PMC10000747 DOI: 10.3390/cancers15051513] [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: 01/27/2023] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
The purpose of our study is to examine whether cancer and treatments are associated with job loss or changes in employment status. Eight prospective studies were included in the systematic review and meta-analysis, with a population aged 18-65 years, analyzing treatment regimen and psychophysical and social status in post-cancer follow-up of at least 2 years. In the meta-analysis, a comparison was made between recovered unemployed cases and cases from a standard reference population. Results are summarized graphically using a forest plot. We showed that cancer and subsequent treatment are risk factors for unemployment with an overall relative risk of 7.24 (lnRR: 1.98, 95% CI: 1.32-2.63) or for change in employment status. Individuals undergoing chemotherapy and/or radiation treatment and those with brain and colorectal cancers are more likely to develop disabilities that negatively affect the risk of unemployment. Finally, variables such as low level education, female sex, older age, and being overweight before starting therapy are associated with higher risk of unemployment. In the future, it will be necessary for people with cancer to have access to specific health, social welfare, and employment support programs. In addition, it is desirable that they become more involved in their choice of therapeutic treatment.
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The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review. Acta Neurochir (Wien) 2022; 164:2789-2809. [PMID: 35945356 DOI: 10.1007/s00701-022-05339-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/02/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE For a long time, return to work (RTW) has been neglected in patients harboring a diffuse low-grade glioma (LGG). However, a majority of LGG patients worked at time of diagnosis. Moreover, these patients now live longer given current treatment paradigms, especially thanks to early maximal surgery. METHODS We systematically searched available medical databases for studies that reported data on RTW in patients who underwent resection for LGG. RESULTS A total of 30 studies were selected: 19 considered RTW (especially rate and timing) as an outcome and 11 used scales of health-related quality of life (HRQoL) which included work-related aspects. Series that considered RTW as a main endpoint were composed of 1014 patients, with postoperative RTW rates ranging from 31 to 97.1% (mean 73.1%). Timing to RTW ranged from 15 days to 22 months (mean 6.3 months). Factors related to an increased proportion of RTW were: younger age, better neurologic status, having a white-collar occupation, working pre-operatively, being the sole breadwinner, the use of awake surgery, and greater extent of resection. Female sex, older age, poor neurologic status, pre-operative history of work absences, slow lexical access speed, and postoperative seizures were negatively related to RTW. No studies that used HRQoL scales directly investigated RTW rate or timing. CONCLUSIONS RTW was scarcely analyzed in LGG patients who underwent resection. However, because they are usually young, with no or only mild functional deficits and have a longer life expectancy, postoperative RTW should be assessed more systematically and accurately as a main outcome. As majority (61.5-100%) of LGG patients were working at time of surgery, the responsibility of neurosurgeons is to bring these patients back to their previous activities according to his/her wishes. RTW might also be included as a critical endpoint for future prospective studies and randomized control trials on LGGs.
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Ghasempour M, purabdollah M, Rahmani A, dehghannezhad J, Mousavi S, Sattarpour S. The Relation of Work Ability and Return to Work Among Iranian Cancer Survivors. Asian Pac J Cancer Prev 2022; 23:3339-3346. [PMID: 36308357 PMCID: PMC9924310 DOI: 10.31557/apjcp.2022.23.10.3339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cancerous diseases are known to disrupt a person's ability and inflict physical, psychological, financial, and social complications on the person, thereby challenging an individual's returning to work. The aim of this study was to investigate the ability of cancer patients to work after returning to work. METHODS This descriptive-correlational study examined a total of 227 surviving cancer patients, having picked the participants through convenience sampling. Data were collected by the return to work and work ability index (WAI) questionnaires and analyzed by descriptive statistics and inferential statistics using SPSS software. RESULTS A total of 166 (73.2%) of the participants had returned to work after completing the basic treatment. The mean (standard deviation) of the work ability score was 29.52 (9.43), ranging from 9 to 43 while the average daily work hours dropped from 12.30 to 5.50. The chi-square test showed a significant relationship between the work ability score and the type of return to work. Moreover, the rank logistic regression analysis revealed that work ability was the most important predictor of return to work. CONCLUSION Survivors of cancer face reduced working hours and limited ability to work after returning to work, and it is possible to facilitate the return to work in these patients by identifying their job needs in relation to their abilities and barriers of returning to work through the appropriate interventions.
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Patient-reported cognitive function before and after glioma surgery. Acta Neurochir (Wien) 2022; 164:2009-2019. [PMID: 35668303 PMCID: PMC9338128 DOI: 10.1007/s00701-022-05261-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/21/2022] [Indexed: 12/03/2022]
Abstract
Background Little is known about the extent to which glioma patients experience subjective changes in cognitive function following surgery. We sought to assess patient-reported cognitive function before and after glioma surgery and explore potential factors associated with cognitive change. Methods In a prospective population-based study, patient-reported cognitive function was measured in 182 patients undergoing primary surgery for diffuse glioma (141 high-grade gliomas (HGG) and 41 low-grade gliomas (LGG)) by using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 cognitive function subscale preoperatively and at 1 and 6 months postoperatively. Binomial logistic regression models were used to assess factors possibly associated with patient-reported cognitive changes. Results In the HGG group, the mean cognitive function score increased from 70.9 (95% 66.6, 75.2) preoperatively to 85.1 (95% CI 81.2, 89.0) (p < 0.001) and 83.3 (95% CI 79.1, 87.6) (p < 0.001) at 1 and 6 months postoperatively, respectively. In the LGG group, the mean score was 80.9 (95% CI 74.4, 87.4) preoperatively and remained stable at postoperative follow-ups. Females reported lower scores than males. At an individual level, both improvement and deterioration in cognitive scores were frequently seen in LGG and HGG patients after surgery. Preoperative use of corticosteroids and large tumor volume were predictors for cognitive improvement at 1 month postoperatively. No predictors were identified for cognitive improvement at 6 months and worsening at 1 and 6 months. Conclusion Many glioma patients experience perioperative subjective changes in cognitive function after surgery. At group level, HGG patients reported improved cognitive function after surgery, while LGG patients reported stable cognitive function. Preoperative use of corticosteroids and large tumor volume were independently associated with postoperative improvement.
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14
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Reitz SC, Behrens M, Lortz I, Conradi N, Rauch M, Filipski K, Voss M, Kell C, Czabanka M, Forster MT. Neurocognitive Outcome and Seizure Freedom After Awake Surgery of Gliomas. Front Oncol 2022; 12:815733. [PMID: 35463387 PMCID: PMC9023117 DOI: 10.3389/fonc.2022.815733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Gliomas are often diagnosed due to epileptic seizures as well as neurocognitive deficits. First treatment choice for patients with gliomas in speech-related areas is awake surgery, which aims at maximizing tumor resection while preserving or improving patient’s neurological status. The present study aimed at evaluating neurocognitive functioning and occurrence of epileptic seizures in patients suffering from gliomas located in language-related areas before and after awake surgery as well as during their follow up course of disease. Materials and Methods In this prospective study we included patients who underwent awake surgery for glioma in the inferior frontal gyrus, superior temporal gyrus, or anterior temporal lobe. Preoperatively, as well as in the short-term (median 4.1 months, IQR 2.1-6.0) and long-term (median 18.3 months, IQR 12.3-36.6) postoperative course, neurocognitive functioning, neurologic status, the occurrence of epileptic seizures and number of antiepileptic drugs were recorded. Results Between 09/2012 and 09/2019, a total of 27 glioma patients, aged 36.1 ± 11.8 years, were included. Tumor resection was complete in 15, subtotal in 6 and partial in 6 patients, respectively. While preoperatively impairment in at least one neurocognitive domain was found in 37.0% of patients, postoperatively, in the short-term, 36.4% of patients presented a significant deterioration in word fluency (p=0.009) and 34.8% of patients in executive functions (p=0.049). Over the long-term, scores improved to preoperative baseline levels. The number of patients with mood disturbances significantly declined from 66.7% to 34.8% after surgery (p=0.03). Regarding seizures, these were present in 18 (66.7%) patients prior to surgery. Postoperatively, 22 (81.5%) patients were treated with antiepileptic drugs with all patients presenting seizure-freedom. Conclusions In patients suffering from gliomas in eloquent areas, the combination of awake surgery, regular neurocognitive assessment - considering individual patients´ functional outcome and rehabilitation needs – and the individual adjustment of antiepileptic therapy results in excellent patient outcome in the long-term course.
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Affiliation(s)
- Sarah Christina Reitz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Irina Lortz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Katharina Filipski
- Edinger Institute, Institute of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung), Partner Site Frankfurt/Mainz, Heidelberg, Germany.,German Cancer Research Center (Deutsches Krebsforschungszentrum), Heidelberg, Germany
| | - Martin Voss
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Christian Kell
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marie-Therese Forster
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
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15
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Duffau H. Awake Mapping With Transopercular Approach in Right Insular-Centered Low-Grade Gliomas Improves Neurological Outcomes and Return to Work. Neurosurgery 2022; 91:182-190. [PMID: 35445665 DOI: 10.1227/neu.0000000000001966] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Asleep vs awake surgery for right insula-centered low-grade glioma (LGG) is still debated. OBJECTIVE To compare neurological outcomes and return to work after resection for right insular/paralimbic LGG performed without vs with awake mapping. METHODS A personal surgical experience of right insula-centered LGG was analyzed, by comparing 2 consecutive periods. In the first period (group 1), patients underwent asleep surgery with motor mapping. In the second period (group 2), patients underwent intraoperative awake mapping of movement and cognitive functions. RESULTS This consecutive series included 143 LGGs: 41 in group 1 (1999-2009) and 102 in group 2 (2009-2020). There were no significant difference concerning preoperative clinicoradiological characteristics and histopathology results between both groups. Intraoperative motor mapping was positive in all cases in group 1. In group 2, beyond motor mapping, somatosensory, visuospatial, language, and/or cognitive functions were identified during cortical-subcortical stimulation. Postoperatively, 3 patients experienced a long-lasting deterioration with 2 hemiparesis due to deep stroke (1.3%) and 1 severe depressive syndrome, all of them in group 1 vs none in group 2 (P = .022). The rate of RTW was 81.5% in group 1 vs 95.5% in group 2 (P = .016). The tumor volume and extent of resection did not significantly differ across both groups. CONCLUSION This is the first study comparing asleep vs awake surgery for right insula-centered LGG. Despite similar extent of resection, functional outcomes were significantly better in awake patients by avoiding permanent neurological impairment and by increasing RTW. These results support the mapping of higher-order functions during awake procedure.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Low-grade gliomas," INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
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16
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Butenschoen VM, Gloßner T, Hostettler IC, Meyer B, Wostrack M. Quality of life and return to work and sports after spinal ependymoma resection. Sci Rep 2022; 12:4926. [PMID: 35322104 PMCID: PMC8943200 DOI: 10.1038/s41598-022-09036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Adult spinal ependymoma presents a rare low-grade tumor entity. Due to its incidence peak in the fourth decade of life, it mostly affects patients during a professionally and physically active time of life. We performed a retrospective monocentric study, including all patients operated upon for spinal ependymoma between 2009 and 2020. We prospectively collected data on professional reintegration, physical activities and quality-of-life parameters using EQ-5D and SF-36. Issues encountered were assessed using existing spinal-cord-specific questionnaires and free-text questions. In total, 65 of 114 patients agreed to participate. Most patients suffered from only mild pre- and postoperative impairment on the modified McCormick scale, but 67% confirmed difficulties performing physical activities in which they previously engaged due to pain, coordination problems and fear of injuries after a median follow-up of 5.4 years. We observed a shift from full- to part-time employment and patients unable to work, independently from tumor dignity, age and neurological function. Despite its benign nature and occurrence of formal only mild neurological deficits, patients described severe difficulties returning to their preoperative physical activity and profession. Clinical scores such as the McCormick grade and muscle strength may not reflect the entire self-perceived impairment appropriately.
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Affiliation(s)
- Vicki M Butenschoen
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Till Gloßner
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Isabel C Hostettler
- Department of Neurosurgery, Kantonspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
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17
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Sekely A, Zakzanis KK, Mabbott D, Tsang DS, Kongkham P, Zadeh G, Edelstein K. Long-term neurocognitive, psychological, and return to work outcomes in meningioma patients. Support Care Cancer 2022; 30:3893-3902. [PMID: 35041087 DOI: 10.1007/s00520-022-06838-5] [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: 10/15/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study aimed to investigate long-term neurocognitive, psychological, and return to work (RTW) outcomes in meningioma patients, and to explore whether neurocognitive and psychological factors influence RTW outcomes in this population. METHODS In this retrospective study, 61 meningioma patients completed in-depth clinical neuropsychological assessments. Of these participants, 42 were of working-age and had RTW information available following neuropsychological assessment. Seventy-one percent and 80% of patients received radiation and surgery, respectively, with 49% receiving both radiation and surgery. Associations between demographic, medical, neurocognitive, psychological, and RTW data were analyzed using multivariable logistic regression analyses. RESULTS In our sample, 68% of patients exhibited global neurocognitive impairment, with the largest effect sizes found on tests of visual memory (d = 0.73), executive function (d = 0.61), and attention (d = 0.54). Twenty-seven percent exhibited moderate to severe levels of depressive symptoms. In addition, 23% and 30% exhibited clinically significant state and trait anxiety, respectively. Forty-eight percent of patients were unable to RTW. Younger age, faster visuomotor processing speed, and, unexpectedly, higher trait anxiety scores were associated with an increased likelihood of returning to work. CONCLUSIONS Meningioma patients are at risk of experiencing neurocognitive deficits, psychological symptoms, and difficulties returning to work. Our results suggest that neurocognitive and psychological factors contribute to RTW status in meningioma patients. Prospective research studies are necessary to increase our understanding of the complexity of functional disability in this growing population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada. .,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Department of Psychology, Neurosciences, and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Svedung Wettervik T, Munkhammar ÅA, Jemstedt M, Ersson M, Latini F, Ryttlefors M, Zetterling M. Dynamics in cognition and health-related quality of life in grade 2 and 3 gliomas after surgery. Acta Neurochir (Wien) 2022; 164:3275-3284. [PMID: 36331612 PMCID: PMC9705489 DOI: 10.1007/s00701-022-05408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The focus of clinical management and research in gliomas has been on survival, but the interest in the treatment effects on cognition and health-related quality of life (HRQoL) is emerging. The primary aim of this study was to investigate the dynamics in cognition after brain tumor surgery for astrocytomas and oligodendrogliomas grade 2 and 3. The secondary aim was to investigate the association of postoperative changes in cognition with changes HRQoL. METHODS In this observational study, 48 patients operated for an astrocytoma or oligodendrogliomas, grade 2 or 3, at the Department of Neurosurgery, Uppsala, Sweden, 2016-2021, were included. Cognitive and language skills were assessed with a selected test battery and HRQoL was patient-reported as assessed with RAND-36 pre- and approximately 3 months postoperatively. RESULTS There was a significant postoperative decrease in attention span and verbal learning, but the patients improved in the test for visual memory. There was no change in visual attention, executive function, verbal memory, visual organization and construction, verbal fluency, and confrontation naming. The RAND-36 variables physical function, role physical, general health, vitality, and social functioning decreased significantly after surgery. Patients operated for tumor recurrence exhibited greater deterioration in attention and a greater extent of resection correlated with a less pronounced decrease in verbal memory, but there were otherwise weak associations between the dynamics in cognition and patient-, tumor-, and treatment-variables. A decline in cognitive variables was not associated with worse HRQoL. CONCLUSIONS Although both several cognitive and HRQoL domains deteriorated postoperatively, these changes did not correlate with each other. This highlights the complexity of cognitive and HRQoL dynamics in the early postoperative phase.
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Affiliation(s)
- Teodor Svedung Wettervik
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Åsa A. Munkhammar
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Malin Jemstedt
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Marcus Ersson
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Francesco Latini
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Mats Ryttlefors
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Maria Zetterling
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
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Hamdan N, Duffau H. Extending the multistage surgical strategy for recurrent initially low-grade gliomas: functional and oncological outcomes in 31 consecutive patients who underwent a third resection under awake mapping. J Neurosurg 2021; 136:1035-1044. [PMID: 34507287 DOI: 10.3171/2021.3.jns21264] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Maximal safe resection is the first treatment in diffuse low-grade glioma (DLGG). Due to frequent tumor recurrence, a second surgery has already been reported, with favorable results. This study assesses the feasibility and functional and oncological outcomes of a third surgery in recurrent DLGG. METHODS Patients with DLGG who underwent a third functional-based resection using awake mapping were consecutively selected. They were classified into group 1 in cases of slow tumor regrowth or group 2 if a radiological enhancement occurred during follow-up. All data regarding clinicoradiological features, histomolecular results, oncological treatment, and survival were collected. RESULTS Thirty-one patients were included, with a median age of 32 years. There were 20 astrocytomas and 11 oligodendrogliomas in these patients. Twenty-one patients had medical oncological treatment before the third surgery, consisting of chemotherapy in 19 cases and radiotherapy in 8 cases. No neurological deficit persisted after the third resection except mild missing words in 1 patient, with 84.6% of the patients returning to work. The median follow-up duration was 13.1 ± 3.4 years since diagnosis, and 3.1 ± 2.9 years since the third surgery. The survival rates at 7 and 10 years were 100% and 89.7%, respectively, with an estimated median overall survival of 17.8 years since diagnosis. A comparison between the groups showed that the Karnofsky Performance Scale score dropped below 80 earlier in group 2 (14.3 vs 17.1 years, p = 0.01). Median residual tumor volume at the third surgery was smaller (2.8 vs 14.4 cm3, p = 0.003) with a greater extent of resection (89% vs 70%, p = 0.003) in group 1. CONCLUSIONS This is the first consecutive series showing evidence that, in select patients with progressive DLGG, a third functional-based surgery can be achieved using awake mapping with low neurological risk and a high rate of total resection, especially when reoperation is performed before malignant transformation.
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Affiliation(s)
- Noor Hamdan
- 1Department of Neurosurgery, Jean Minjoz Hospital, Besançon University Medical Center, Besançon.,2University of Bourgogne-Franche-Comté, Besançon
| | - Hugues Duffau
- 3Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier.,4Team "Plasticity of Central Nervous System, Stem Cells and Low-Grade Gliomas," INSERM U1191, Institute of Functional Genomics, Montpellier; and.,5University of Montpellier, France
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20
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Corniola MV, Meling TR. Functional outcome and quality of life after meningioma surgery: a systematic review. Acta Neurol Scand 2021; 143:467-474. [PMID: 33464578 DOI: 10.1111/ane.13395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
Assessment of long-term functional outcomes after meningioma surgery is important. We systematically reviewed the literature on health-related quality of life (HrQoL) and functional disability (FD) of patients after surgery for intracranial meningiomas. Using PRISMA 2015 guidelines, we screened 289 abstracts and 43 titles were retained for full-paper screening. 15 articles did not present enough data to meet the inclusion criteria and 7 articles failed to assess functional assessment and HrQoL. Twenty-two articles were included in our review. HrQol was assessed in N = 18 publications, most frequently using SF-36 (N = 10), followed by EQ5D-5L (N = 4), EORTC-QLQ (N = 4), and the FACT questionnaire (N = 2). The assessment of FD was reported in N = 11 publications, mostly using the KPS (N = 8). The Barthel index was used in N = 2 publications. Follow-up was reported in N = 12 publications, ranging from 6 months to 9 years. Scientific publications assessing long-term postoperative HrQol and FD in patients undergoing meningioma surgery are scarce and the data are heterogeneously reported, using various scales and follow-up protocols. Efforts should be undertaken to uniformly assess long-term post-operative functional outcomes in meningioma patients.
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Affiliation(s)
- Marco V. Corniola
- Neurosurgery Department Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Torstein R. Meling
- Neurosurgery Department Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
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21
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Brain connectomics applied to oncological neuroscience: from a traditional surgical strategy focusing on glioma topography to a meta-network approach. Acta Neurochir (Wien) 2021; 163:905-917. [PMID: 33564906 DOI: 10.1007/s00701-021-04752-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
The classical way for surgical selection and planning in cerebral glioma mainly focused on tumor topography. The emerging science of connectomics, which aims of mapping brain connectivity, resulted in a paradigmatic shift from a modular account of cerebral organization to a meta-network perspective. Adaptive behavior is actually mediated by constant changes in interactions within and across large-scale delocalized neural systems underlying conation, cognition, and emotion. Here, to optimize the onco-functional balance of glioma surgery, the purpose is to switch toward a connectome-based resection taking account of both relationships between the tumor and critical distributed circuits (especially subcortical pathways) as well as the perpetual instability of the meta-network. Such dynamic in the neural spatiotemporal integration permits functional reallocation leading to neurological recovery after massive resection in structures traditionally thought as "inoperable." This better understanding of connectome increases benefit/risk ratio of surgery (i) by selecting resection in areas deemed "eloquent" according to a localizationist dogma; (ii), conversely, by refining intraoperative awake cognitive mapping and monitoring in so-called non-eloquent areas; (iii) by improving preoperative information, enabling an optimal selection of intrasurgical tasks tailored to the patient's wishes; (iv) by developing an "oncological disconnection surgery"; (v) by defining a personalized multistep surgical strategy adapted to individual brain reshaping potential; and (vi) ultimately by preserving environmentally and socially appropriate behavior, including return to work, while increasing the extent of (possibly repeated) resection(s). Such a holistic vision of neural processing can enhance reliability of connectomal surgery in oncological neuroscience and may also be applied to restorative neurosurgery.
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Duffau H. Updated perspectives on awake neurosurgery with cognitive and emotional assessment for patients with low-grade gliomas. Expert Rev Neurother 2021; 21:463-473. [PMID: 33724148 DOI: 10.1080/14737175.2021.1901583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Thanks to early extensive surgical resection combined with medical oncological therapies, life expectancy dramatically increased in low-grade glioma (LGG), with an overall survival currently over 15 years. Therefore, patients should be able to maintain valuable family and socio-professional activities.Areas covered: For many decades, cognitive and emotional aspects were neglected by surgical and medical neurooncologists. The goal of surgery was to avoid hemiplegia and/or aphasia, with no considerations regarding behavior. However, because LGG patients live longer, they must be cognitively and affectively able to make long-term projects. Preservation of higher-order functions should be considered systematically in LGG surgery by means of awake cognitive/emotional mapping and monitoring.Expert opinion: The aim is to incorporate recent advances in neurosciences, which proposed revisited models of cerebral processing relying on a meta-network perspective, into the pre-, intra- and postoperative procedure. In this connectomal approach, brain functions result from complex interactions within and between neural networks. This improved understanding of a constant instability of the neural system allows a better cognitive/emotional assessment before and after each treatment over years, in order to preserve personality and adaptive behavior for each LGG patient, based on his/her own definition of quality of life. It is time to create oncological neurosciences.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery Gui De Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1191 Laboratory Team "Brain Plasticity, Stem Cells and Low-Grade Gliomas", Institute of Functional Genomic, University of Montpellier, Montpellier, France
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Schiavolin S, Mariniello A, Broggi M, Acerbi F, Schiariti M, Franzini A, Di Meco F, Ferroli P, Leonardi M. Characteristics of Patients Returning to Work After Brain Tumor Surgery. Front Hum Neurosci 2021; 14:609080. [PMID: 33613204 PMCID: PMC7886680 DOI: 10.3389/fnhum.2020.609080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the differences between patients returning to work and those who did not after brain tumor surgery. Methods: Patients were evaluated before surgery and after 3 months. The Montreal Cognitive Assessment test, Trail-Making Test (parts A and B), 15-word Rey–Osterrieth Word List (immediate and delayed recall), F-A-S tests, and Karnosfky Performance Status were used to assess cognitive status, attention, executive functions, memory, word fluency, and functional status. Patient-reported outcome measures (PROMs) used to evaluate emotional distress and disability were the Hospital Anxiety and Depression Scale and World Health Organization Disability Assessment Schedule. Clinical and work-related variables, PROMs, and cognitive tests were compared using chi-squared, t-test or Mann–Whitney U test. Results: Sixty patients were included. Patients returning to work were 61.3 and 31.0% among people with meningioma and glioma, respectively. They reported lower postoperative disability and lesser home-to-work travel time. Patients with meningioma also showed better preoperative and postoperative attention and executive functions, better postoperative functional and cognitive status, and lower frequency of treatments. Conclusions: These variables should be considered in a clinical context to plan interventions for people who need support during return to work and in future research to investigate preoperative and postoperative predictive factors of going back to work.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Arianna Mariniello
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angelo Franzini
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
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