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Li J, Che Z, Wan X, Manshaii F, Xu J, Chen J. Biomaterials and bioelectronics for self-powered neurostimulation. Biomaterials 2024; 304:122421. [PMID: 38065037 DOI: 10.1016/j.biomaterials.2023.122421] [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: 10/23/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
Self-powered neurostimulation via biomaterials and bioelectronics innovation has emerged as a compelling approach to explore, repair, and modulate neural systems. This review examines the application of self-powered bioelectronics for electrical stimulation of both the central and peripheral nervous systems, as well as isolated neurons. Contemporary research has adeptly harnessed biomechanical and biochemical energy from the human body, through various mechanisms such as triboelectricity, piezoelectricity, magnetoelasticity, and biofuel cells, to power these advanced bioelectronics. Notably, these self-powered bioelectronics hold substantial potential for delivering neural stimulations that are customized for the treatment of neurological diseases, facilitation of neural regeneration, and the development of neuroprosthetics. Looking ahead, we expect that the ongoing advancements in biomaterials and bioelectronics will drive the field of self-powered neurostimulation toward the realization of more advanced, closed-loop therapeutic solutions, paving the way for personalized and adaptable neurostimulators in the coming decades.
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Affiliation(s)
- Jinlong Li
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Ziyuan Che
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Xiao Wan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Farid Manshaii
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jing Xu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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Milbury K, Whisenant M, Weathers S, Malliaha S, Snyder S, Jackson N, Li J, Li Y, Silva RF, Shih YT, Cohen L. Dyadic versus individual delivery of a yoga program for family caregivers of glioma patients undergoing radiotherapy: Results of a
3‐arm
randomized controlled trial. Cancer Med 2022; 12:7567-7579. [PMID: 36468605 PMCID: PMC10067051 DOI: 10.1002/cam4.5514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite their significant distress, supportive care interventions for caregivers of glioma patients are generally lacking. And, whether caregivers are more likely to benefit from interventions targeting patient-caregiver dyads or caregivers individually is unknown. This pilot randomized controlled trial compared the feasibility and preliminary efficacy of a dyadic yoga (DY) versus an individual caregiver yoga (CY) intervention as a supportive care strategy for family caregivers. METHODS Patient-caregiver dyads were randomized to a DY, CY or usual care (UC) arm. DY and CY interventions were delivered over 15 sessions. Caregivers completed assessments of their depressive symptoms, quality of life (QOL), and caregiving reactions at baseline, 6 weeks, and 12 weeks, and a subset completed qualitative interviews at 12 weeks. RESULTS With a consent rate of 63%, 67 dyads were randomized. Attendance in the DY was higher than in the CY group (session means, DY = 12.23, CY = 9.00; p = 0.06). Caregivers (79% female; 78% non-Hispanic White; mean age, 53 years) reported significantly more subjective benefit in the CY arm than in the DY arm (d = 2.1; p < .01), which was consistent with the qualitative assessment. There were medium effect sizes for improved mental QOL (d = 0.46) and financial burden (d = 0.53) in favor of the CY over the UC group. Caregivers in the CY group reported more caregiving esteem (d = 0.56) and less health decline (d = 0.60) than those in the DY group. CONCLUSION Individual rather than dyadic delivery may be a superior supportive care approach for this vulnerable caregiver population. A larger, adequately powered efficacy trial is warranted.
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Affiliation(s)
- Kathrin Milbury
- The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Meagan Whisenant
- The University of Texas MD Anderson Cancer Center Houston Texas USA
- The University of Texas Health Science Center at Houston, Cizik School of Nursing Houston Texas USA
| | | | - Smitha Malliaha
- The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Stella Snyder
- The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Natalie Jackson
- The University of Texas MD Anderson Cancer Center Houston Texas USA
- The University of Texas Health Science Center at Houston, Cizik School of Nursing Houston Texas USA
| | - Jing Li
- The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Yisheng Li
- The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | | | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center Houston Texas USA
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3
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Tunthanathip T, Sae-heng S, Oearsakul T, Kaewborisutsakul A, Inkate S, Madteng S, Tanvejsilp P. Quality of life, out-of-pocket expenditures, and indirect costs among patients with the central nervous system tumors in Thailand. J Neurosci Rural Pract 2022; 13:740-749. [PMID: 36743773 PMCID: PMC9894017 DOI: 10.25259/jnrp-2022-3-45] [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: 03/23/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives The aim of this study was to investigate out-of-pocket (OOP) expenditures, indirect costs, and health-related quality of life (HRQoL) associated with the central nervous system (CNS) tumors in Thailand. Materials and Methods A prospective study of CNS tumor patients who underwent first tumor resection at a tertiary care institution in Thailand was conducted. Patients were interviewed during hospitalization for undergoing first surgery. Within 6 months, they were interviewed once more if the disease continued to progress. Costs collected from a patient perspective and converted to 2019 US dollars. For dealing with these skewed data, a generalized linear model was used to investigate the effects of disease severity (malignancy, progressive disease, Karnofsky performance status score, and histology) and other factors on costs (OOP, informal care, productivity loss, and total costs). P < 0.05 was considered statistical significant for all analysis. Results Among a total of 123 intracranial CNS tumor patients, there were 83 and 40 patients classified into benign and malignant, respectively. In the first brain surgery, there was no statistical difference in HRQoL between patients with benign and malignant tumors (P = 0.072). However, patients with progressive disease had lower HRQoL mean scores at pre-operative and progressive disease periods were 0.711 (95% confidence interval [CI]: 0.662-0.760) and 0.261 (95% CI: 0.144-0.378), respectively. Indirect expenditures were the primary cost driver, accounting for 73.81% of annual total costs. The total annual costs accounted for 59.81% of the reported patient's income in malignant tumor patients. The progressive disease was the only factor that was significantly increases in all sorts of costs, including the OOP (P = 0.001), the indirect costs (P = 0.013), and the total annual costs (P = 0.001). Conclusion Although there was no statistical difference in HRQoL and costs between patients with benign and malignant tumor, the total costs accounted for more than half of the reported income in malignant tumor patients. The primary cause of significant increases in all costs categories was disease progression.
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Affiliation(s)
- Thara Tunthanathip
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sakchai Sae-heng
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thakul Oearsakul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Anukoon Kaewborisutsakul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Srirat Inkate
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Suphavadee Madteng
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pimwara Tanvejsilp
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
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4
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Rogers JL, De La Cruz Minyety J, Vera E, Acquaye AA, Payén SS, Weinberg JS, Armstrong TS, Weathers SPS. Assessing mobility in primary brain tumor patients: A descriptive feasibility study using two established mobility tests. Neurooncol Pract 2022; 9:219-228. [PMID: 35601968 PMCID: PMC9113321 DOI: 10.1093/nop/npac013] [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] [Indexed: 11/12/2022] Open
Abstract
Background Patients with primary brain tumors (PBT) face significant mobility issues related to their disease and/or treatment. Here, the authors describe the preliminary utility and feasibility of two established mobility measures, the Timed-Up-and-Go (TUG) and Five-Times Sit-to-Stand (TSS) tests, in quickly and objectively assessing the mobility status of PBT patients at a single institution's neuro-oncology clinic. Methods Adult patients undergoing routine PBT care completed the TUG/TSS tests and MD Anderson Symptom Inventory-Brain Tumor module (MDASI-BT), which assessed symptom burden and interference with daily life, during clinic visits over a 6-month period. Research staff assessed feasibility metrics, including test completion times/rates, and collected demographic, clinical, and treatment data. Mann-Whitney tests, Kruskal-Wallis tests, and Spearman's rho correlations were used to interrogate relationships between TUG/TSS test completion times and patient characteristics. Results The study cohort included 66 PBT patients, 59% male, with a median age of 47 years (range: 20-77). TUG/TSS tests were completed by 62 (94%) patients. Older patients (P < .001) and those who were newly diagnosed (P = .024), on corticosteroids (P = .025), or had poor (≤80) KPS (P < .01) took longer to complete the TUG/TSS tests. Worse activity-related (work, activity, and walking) interference was associated with longer TUG/TSS test completion times (P < .001). Conclusions The TUG/TSS tests are feasible for use among PBT patients and may aid in clinical care. Older age, being newly diagnosed, using corticosteroids, poor (≤80) KPS, and high activity-related interference were associated with significant mobility impairment, highlighting the tests' potential clinical utility. Future investigations are warranted to longitudinally explore feasibility and utility in other practice and disease settings.
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Affiliation(s)
- James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA,Corresponding Author: James L. Rogers, BS, Cancer Research Training Award Fellow, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd., Bethesda, MD 20892, USA ()
| | - Julianie De La Cruz Minyety
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina A Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Samuel S Payén
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shiao-Pei S Weathers
- Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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5
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Porter AB, Liu H, Kohli S, Cerhan JL, Sloan J, McMurray RP, Le-Rademacher J, Loprinzi CL, Villano JL, Kizilbash SH, Mehta MP, Jaeckle KA, Brown PD. Efficacy of Treatment With Armodafinil for Cancer-Related Fatigue in Patients With High-grade Glioma: A Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 8:259-267. [PMID: 34882169 DOI: 10.1001/jamaoncol.2021.5948] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nearly 96% of patients with high-grade glioma (HGG) report moderate-to-severe fatigue. Armodafinil is a psychostimulant that might help cancer-related fatigue in patients with HGG. Objective To determine whether armodafinil reduces fatigue in patients with HGG and moderate-to-severe fatigue. Design, Setting, and Participants In this randomized multicenter, phase 3, double-blinded, placebo-controlled clinical trial, adults with HGG and moderate-to-severe fatigue who were clinically stable at least 4 weeks after completing radiation therapy were randomized to receive armodafinil daily (150 mg or 250 mg) or placebo over 8 weeks. A score of at least 6 out of 10 on severity scale for the brief fatigue inventory scale, with 10 being the worst, was required to suggest moderate-to-severe fatigue. Patients were allowed stable doses of corticosteroids but were excluded if they required increasing amounts of corticosteroids, were receiving some other treatment for fatigue, or had an uncontrolled seizure disorder. The study was conducted from June 2013 to December 15, 2019. Interventions Patients were randomized to 150 mg of armodafinil, 250 mg of armodafinil, or placebo for a total of 8 weeks with assessments at weeks 4 and 8. Main Outcomes and Measures The primary outcome was efficacy in treating cancer-related fatigue. Secondary outcomes included safety, neurocognitive function, and quality of life. Patients were evaluated at baseline and at weeks 4 and 8. Efficacy between the placebo and the 2 doses of study drug was determined by an improvement by 2 points on the 0 to 10 brief fatigue inventory scale. Kruskal-Wallis and χ2 tests were used and followed by confirmatory analyses. Results A total of 328 patients were enrolled, of whom 297 had evaluable end point data. Of these, 103 received 150 mg of armodafinil (mean [SD] age, 58.5 [11.9] years; 42 women [40.8%]), 97 250 mg of armodafinil (mean [SD] age, 56.6 [12.5] years; 37 women [38.1%]), and 97 placebo (mean [SD] age, 57.1 [12.5] years; 39 women [40.2%]). There was no difference in the proportion of patients who achieved clinically meaningful fatigue reduction between arms (28% [95% CI 20%-30%] for 150 mg of armodafinil, 28% [95% CI 19%-38%] for 250 mg of armodafinil, and 30% [95% CI 21%-40%] for placebo). There was a statistically significant reduction in global fatigue for corticosteroid users compared with nonusers (-0.7 [95% CI, -1.5 to -0.3] vs -1.7 [95% CI, -2.1 to -1.3]; P < .001). More patients (2 vs 7) reported insomnia with treatment with 250 mg of armodafinil. Conclusions and Relevance The results of this randomized clinical trial found no meaningful benefit of using treatment with armodafinil to reduce cancer-related fatigue in patients with HGG. Trial Registration ClinicalTrials.gov Identifier: NCT01781468.
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Affiliation(s)
| | - Heshan Liu
- Mayo Clinic, Rochester, Minnesota.,Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jeff Sloan
- Mayo Clinic, Rochester, Minnesota.,Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Ryan P McMurray
- Mayo Clinic, Rochester, Minnesota.,Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jennifer Le-Rademacher
- Mayo Clinic, Rochester, Minnesota.,Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | | | - John L Villano
- University of Kentucky/Markey Cancer Center, Lexington, Kentucky
| | | | - Minesh P Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
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6
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Preoperative Assessment of Language Dominance through Combined Resting-State and Task-Based Functional Magnetic Resonance Imaging. J Pers Med 2021; 11:jpm11121342. [PMID: 34945814 PMCID: PMC8706548 DOI: 10.3390/jpm11121342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Brain lesions in language-related cortical areas remain a challenge in the clinical routine. In recent years, the resting-state fMRI (RS-fMRI) was shown to be a feasible method for preoperative language assessment. The aim of this study was to examine whether language-related resting-state components, which have been obtained using a data-driven independent-component-based identification algorithm, can be supportive in determining language dominance in the left or right hemisphere. Twenty patients suffering from brain lesions close to supposed language-relevant cortical areas were included. RS-fMRI and task-based (TB-fMRI) were performed for the purpose of preoperative language assessment. TB-fMRI included a verb generation task with an appropriate control condition (a syllable switching task) to decompose language-critical and language-supportive processes. Subsequently, the best fitting ICA component for the resting-state language network (RSLN) referential to general linear models (GLMs) of the TB-fMRI (including models with and without linguistic control conditions) was identified using an algorithm based on the Dice index. Thereby, the RSLNs associated with GLMs using a linguistic control condition led to significantly higher laterality indices than GLM baseline contrasts. LIs derived from GLM contrasts with and without control conditions alone did not differ significantly. In general, the results suggest that determining language dominance in the human brain is feasible both with TB-fMRI and RS-fMRI, and in particular, the combination of both approaches yields a higher specificity in preoperative language assessment. Moreover, we can conclude that the choice of the language mapping paradigm is crucial for the mentioned benefits.
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7
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Loughan AR, Husain M, Ravyts SG, Willis KD, Braun SE, Brechbiel JK, Aslanzadeh FJ, Rodin G, Svikis DS, Thacker L. Death anxiety in patients with primary brain tumor: Measurement, prevalence, and determinants. Palliat Support Care 2021; 19:672-680. [PMID: 36942577 DOI: 10.1017/s1478951521000808] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigated death anxiety in patients with primary brain tumor (PBT). We examined the psychometric properties of two validated death anxiety measures and determined the prevalence and possible determinants of death anxiety in this often-overlooked population. METHODS Two cross-sectional studies in neuro-oncology were conducted. In Study 1, 81 patients with PBT completed psychological questionnaires, including the Templer Death Anxiety Scale (DAS). In Study 2, 109 patients with PBT completed similar questionnaires, including the Death and Dying Distress Scale (DADDS). Medical and disease-specific variables were collected across participants in both studies. Psychometric properties, including construct validity, internal consistency, and concurrent validity, were investigated. Levels of distress were analyzed using frequencies, and determinants of death anxiety were identified using logistic regression. RESULTS The DADDS was more psychometrically sound than the DAS in patients with PBT. Overall, 66% of PBT patients endorsed at least one symptom of distress about death and dying, with 48% experiencing moderate-severe death anxiety. Generalized anxiety symptoms and the fear of recurrence significantly predicted death anxiety. SIGNIFICANCE OF RESULTS The DADDS is a more appropriate instrument than the DAS to assess death anxiety in neuro-oncology. The proportion of patients with PBT who experience death anxiety appears to be higher than in other advanced cancer populations. Death anxiety is a highly distressing symptom, especially when coupled with generalized anxiety and fears of disease progression, which appears to be the case in patients with PBT. Our findings call for routine monitoring and the treatment of death anxiety in neuro-oncology.
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Affiliation(s)
- Ashlee R Loughan
- School of Medicine, Virginia Commonwealth University, Richmond, VA
- Massey Cancer Center, Richmond, VA
| | - Mariya Husain
- School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Scott G Ravyts
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Kelcie D Willis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Sarah Ellen Braun
- School of Medicine, Virginia Commonwealth University, Richmond, VA
- Massey Cancer Center, Richmond, VA
| | - Julia K Brechbiel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Farah J Aslanzadeh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dace S Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Leroy Thacker
- Massey Cancer Center, Richmond, VA
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
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8
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Giovagnoli AR, Meneses RF, Paterlini C, Silvani A, Boiardi A. Cognitive awareness after treatment for high-grade glioma. Clin Neurol Neurosurg 2021; 210:106953. [PMID: 34607197 DOI: 10.1016/j.clineuro.2021.106953] [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: 06/06/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In patients with brain lesion, awareness of cognitive deficits is an important aspect of disease awareness. Glioblastoma (GBM) and anaplastic astrocytoma (AA) can cause cognitive deficits, but, to date, awareness of these deficits has not been documented. This study aimed to test cognitive awareness in these patients after the end of treatment. METHODS Fifty patients with GBM or AA were assessed using the Multiple Ability Self-Report Questionnaire (MASQ), State-Trait Anxiety Inventory (STAI), Self Rating Depression Scale (SRDS), and memory, attention, mental speed, abstract reasoning, and flexibility neuropsychological tests. Cognitive awareness was calculated as the concordance between the composite score of neuropsychological performance (PEC) and the total MASQ score. The controls were 48 healthy subjects. Analysis of variance and regression analysis compared subject groups and explored variables predicting perceived abilities. RESULTS Patients with GBM or AA showed similar attention, memory, and executive deficits compared with controls. Cognitive awareness was fair/full in 64% of patients. In the entire patients group, the worst MASQ scores were associated with neuropsychological deficits, anxiety, depression, and glioma location in the right hemisphere . In patients with fair/full awareness, MASQ scores were related to affective status and neuropsychological performance, whereas, in those with scarce/no awareness, they were related only to affective status. CONCLUSIONS After treatment, many patients with GBM or AA are aware of their cognitive deficits. Anxiety, depression, and right hemisphere tumour exacerbate the perceived difficulties. This neurocognitive approach expands the behavioural phenotypes of high-grade gliomas and may have therapeutic implications over the course of the disease.
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Affiliation(s)
- Anna Rita Giovagnoli
- Neurology and Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | | | - Chiara Paterlini
- Neurology and Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Antonio Silvani
- Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Amerigo Boiardi
- Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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9
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Lim MJR. Letter: Functional Outcomes and Health-Related Quality of Life Following Glioma Surgery. Neurosurgery 2021; 89:E187-E188. [PMID: 34131740 DOI: 10.1093/neuros/nyab214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery University Surgical Centre National University Hospital Singapore
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10
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Lo YT, Ang YLS, Yang VS, Kanavathy DT, Liang S, Lee L. Motor deficits at presentation and predictors of overall survival in central nervous system lymphomas. J Neurooncol 2021; 151:295-306. [PMID: 33398535 DOI: 10.1007/s11060-020-03665-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Central nervous system lymphomas (CNSL) can present with motor and non-motor symptoms. In many central nervous system tumors, motor deficits are associated with significant morbidity and functional impairment, and correlate with worse prognosis. CNSLs however, often exhibit remarkable response to chemotherapy and radiotherapy with corresponding symptom improvement. We investigate the survival outcomes and trajectories of motor and functional recovery in a cohort of patients presenting with and without initial motor deficits. METHODS Patients who underwent biopsy and with a histologically confirmed CNSL between 2008 and 2019 were retrospectively identified. Baseline demographic variables, comorbidities, presenting symptoms, histological type, neuroimaging features (location and number of lesions), and treatment administered (pre- and post-operative steroid use and chemotherapy regime) were recorded. Dates of death were obtained from the National Registry of Births and Deaths. Motor power and performance status at admission, 1 month and 6 months were determined. RESULTS We identified 119 patients, of whom 34% presented with focal motor deficits. The median overall survival (OS) was 26.6 months. Those with focal motor deficits had longer OS (median 42.4 months) than those without (median 23.3 months; p = 0.047). In multivariate Cox analysis, age (HR 1.04 per year; p = 0.003), CCI (HR 1.31 per point; p < 0.001), leptomeningeal/ependymal involvement (HR 2.53; p = 0.016), thalamus involvement (HR 0.34; p = 0.019), neutrophil:lymphocyte ratio (HR 1.06 per point; p = 0.034), positive HIV status (HR 5.31; p = 0.003), preoperative steroids use (HR 0.49; p = 0.018), postoperative high-dose steroids (HR 0.26; p < 0.001) and postoperative low-dose steroids (HR 0.28; p = 0.010) were significant predictors of OS. By one month, 43% of surviving patients had full power, increasing to 61% by six months. CONCLUSION A significant proportion of patients with initial motor deficits recovered in motor strength by six months. In our population, those presenting with motor deficits had paradoxically better overall survival.
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Affiliation(s)
- Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Department of Neurosurgery, Outram Road, Singapore, 169608, Singapore.
| | - Ya Lyn Samantha Ang
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Outram Road, Singapore, 169608, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Translational Precision Oncology Lab, Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | | | - Sai Liang
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Lester Lee
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Outram Road, Singapore, 169608, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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11
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Tran AD, Fogarty G, Nowak AK, Diaby V, Hong A, Watts C, Morton RL. Cost-Effectiveness of Subsequent Whole-Brain Radiotherapy or Hippocampal-Avoidant Whole-Brain Radiotherapy Versus Stereotactic Radiosurgery or Surgery Alone for Treatment of Melanoma Brain Metastases. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:679-687. [PMID: 32157631 DOI: 10.1007/s40258-020-00560-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND A randomized phase III trial comparing whole-brain radiotherapy (WBRT) to observation following definitive local treatment of intracranial melanoma metastases with neurosurgery and/or stereotactic surgery (SRS) is underway. OBJECTIVE We sought to assess the pre-trial cost-effectiveness of WBRT, hippocampal-avoidant WBRT (HA-WBRT), and observation (SRS or surgery alone) for this population to guide trial data collection efforts and reduce decision uncertainty. METHODS: A time-dependent Markov model followed patients treated with neurosurgery or SRS who received subsequent WBRT, HA-WBRT or observation over a 5-year time horizon. Model inputs were sourced from published literature and results tested for robustness using probabilistic sensitivity analysis. Value of information (VOI) analysis was undertaken to guide data collection for the randomized trial. RESULTS Over 5 years, the WBRT strategy produced 1.74 QALYs (2.38 life-years) at a mean cost of $40,128 (costs in 2017 Australian dollars); HA-WBRT produced 1.88 QALYs (2.38 life-years) and cost $42,977; and SRS/surgery alone produced 1.65 QALYs (2.13 life-years) at a cost of $46,281. Probabilistic sensitivity analysis showed HA-WBRT was the preferred strategy in 77% of simulations. Cost-effectiveness results were most sensitive to utilities of the controlled-disease health state in the WBRT group, and costs of HA-WBRT. The EVPI for a randomized trial was estimated at $6,888 per person. CONCLUSIONS HA-WBRT may be cost-effective for the treatment of melanoma brain metastases. The results predicted in our model can be validated with prospective trial data when available.
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Affiliation(s)
- Anh Dam Tran
- Health Economics, National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King street, Sydney, NSW, 2031, Australia.
| | - Gerald Fogarty
- St Vincent's Department of Radiotherapy, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Crawley, WA, 6009, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Vakaramoko Diaby
- Health Economics and Outcomes Research, Department of Pharmaceutical Outcomes and Policy (POP), College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Angela Hong
- Melanoma Institute Australia, University of Sydney, North Sydney, NSW, Australia
| | - Caroline Watts
- Melanoma Institute Australia, University of Sydney, North Sydney, NSW, Australia
- Kirby Institute, UNSW, Sydney, NSW, 2052, Australia
| | - Rachael L Morton
- Health Economics, National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King street, Sydney, NSW, 2031, Australia
- Melanoma Institute Australia, University of Sydney, North Sydney, NSW, Australia
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12
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Schei S, Solheim O, Jakola AS, Sagberg LM. Perioperative fatigue in patients with diffuse glioma. J Neurooncol 2020; 147:97-107. [PMID: 31974804 PMCID: PMC7075831 DOI: 10.1007/s11060-020-03403-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
Abstract
Purpose Few studies have assessed fatigue in relation to glioma surgery. The purpose of this study was to explore the prevalence of pre- and postoperative high fatigue, perioperative changes, and factors associated with pre- and postoperative high fatigue in patients undergoing primary surgery for diffuse glioma. Methods A total of 112 adult patients were prospectively included. Patient-reported fatigue was assessed before and one month after surgery using the cancer-specific European Organization for Research and Treatment of Cancer questionnaire fatigue subscale. The scores were dichotomized as high fatigue (≥ 39) or low fatigue (< 39). A change in score of ≥ 10 was considered as a clinically significant change. Factors associated with pre- and postoperative high fatigue were explored in multivariable regression analyses. Results High fatigue was reported by 45% of the patients preoperatively and by 42% of the patients postoperatively. Female gender and low Karnofsky Performance Status (KPS) were associated with preoperative high fatigue, while postoperative complications, low KPS and low-grade histopathology were associated with postoperative high fatigue. In total 35/92 (38%) patients reported a clinically significant improvement of fatigue scores after surgery, 36/92 (39%) patients reported a clinically significant worsening of fatigue scores after surgery, and 21/92 (23%) patients reported no clinically significant change in fatigue scores after surgery. Patients with low-grade gliomas more often reported low fatigue before surgery and high fatigue after surgery, while patients with high-grade gliomas more often reported high fatigue before surgery and low fatigue after surgery. Conclusions Our findings indicate that fatigue is a common symptom in patients with diffuse glioma, both pre- and postoperatively. Perioperative changes were frequently seen. This is important knowledge when informing patients before and after surgery. Electronic supplementary material The online version of this article (10.1007/s11060-020-03403-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stine Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ole Solheim
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
| | - Asgeir Store Jakola
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lisa Millgård Sagberg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
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13
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Haraldseide LM, Jakola AS, Solheim O, Sagberg LM. Does preoperative health-related quality of life predict survival in high-grade glioma patients? - a prospective study. Br J Neurosurg 2019; 34:28-34. [PMID: 31809598 DOI: 10.1080/02688697.2019.1698011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose: To explore if preoperative patient-reported health-related quality of life (HRQoL) provides additional prognostic value as a supplement to other preoperatively known clinical factors in patients with high-grade glioma (HGG).Methods: In a prospective explorative study, 114 patients with high-grade glioma were included. The participants completed the generic HRQoL questionnaire EQ-5D 3L, and the disease-specific questionnaires EORTC QLQ-C30 and EORTC QLQ-BN20 1-3 days before surgery. Operating neurosurgeons scored the patient's preoperative functional level by using Karnofsky Performance Status (KPS). Univariate and multivariate Cox regression analyses were performed to identify HRQoL domains that were associated with survival. Kaplan-Meier survival curves and Log-rank tests were used to visualize differences in survival between groups.Results: In addition to preoperative KPS and age, the EORTC QLQ-BN20 subdomains 'seizures' (HR 0.98, p < .006), 'itchy skin' (HR 1.01, p < .036) and 'bladder control' (HR 1.01, p < .023) were statistically significant independent predictors of survival in a multivariate cox model.Conclusions: Our results suggest that in patients with HGG, certain preoperative symptom scales within EORTC QLQ-BN20 may provide additional prognostic information to supplement other clinical prognostic factors. However, further studies are required to validate our findings. Overall the instruments EQ-5D 3L and EORTC QLQ-C30 do not seem to provide much additional valuable prognostic information to already known prognostic factors.
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Affiliation(s)
- Lisa Marie Haraldseide
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asgeir Store Jakola
- Department of Neurosurgery, St Olavs University Hospital, Trondheim, Norway.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ole Solheim
- Department of Neurosurgery, St Olavs University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lisa Millgård Sagberg
- Department of Neurosurgery, St Olavs University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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14
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Taphoorn MJB, Dirven L, Kanner AA, Lavy-Shahaf G, Weinberg U, Taillibert S, Toms SA, Honnorat J, Chen TC, Sroubek J, David C, Idbaih A, Easaw JC, Kim CY, Bruna J, Hottinger AF, Kew Y, Roth P, Desai R, Villano JL, Kirson ED, Ram Z, Stupp R. Influence of Treatment With Tumor-Treating Fields on Health-Related Quality of Life of Patients With Newly Diagnosed Glioblastoma: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2019; 4:495-504. [PMID: 29392280 DOI: 10.1001/jamaoncol.2017.5082] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Tumor-treating fields (TTFields) therapy improves both progression-free and overall survival in patients with glioblastoma. There is a need to assess the influence of TTFields on patients' health-related quality of life (HRQoL). Objective To examine the association of TTFields therapy with progression-free survival and HRQoL among patients with glioblastoma. Design, Setting, and Participants This secondary analysis of EF-14, a phase 3 randomized clinical trial, compares TTFields and temozolomide or temozolomide alone in 695 patients with glioblastoma after completion of radiochemotherapy. Patients with glioblastoma were randomized 2:1 to combined treatment with TTFields and temozolomide or temozolomide alone. The study was conducted from July 2009 until November 2014, and patients were followed up through December 2016. Interventions Temozolomide, 150 to 200 mg/m2/d, was given for 5 days during each 28-day cycle. TTFields were delivered continuously via 4 transducer arrays placed on the shaved scalp of patients and were connected to a portable medical device. Main Outcomes and Measures Primary study end point was progression-free survival; HRQoL was a predefined secondary end point, measured with questionnaires at baseline and every 3 months thereafter. Mean changes from baseline scores were evaluated, as well as scores over time. Deterioration-free survival and time to deterioration were assessed for each of 9 preselected scales and items. Results Of the 695 patients in the study, 639 (91.9%) completed the baseline HRQoL questionnaire. Of these patients, 437 (68.4%) were men; mean (SD) age, 54.8 (11.5) years. Health-related quality of life did not differ significantly between treatment arms except for itchy skin. Deterioration-free survival was significantly longer with TTFields for global health (4.8 vs 3.3 months; P < .01); physical (5.1 vs 3.7 months; P < .01) and emotional functioning (5.3 vs 3.9 months; P < .01); pain (5.6 vs 3.6 months; P < .01); and leg weakness (5.6 vs 3.9 months; P < .01), likely related to improved progression-free survival. Time to deterioration, reflecting the influence of treatment, did not differ significantly except for itchy skin (TTFields worse; 8.2 vs 14.4 months; P < .001) and pain (TTFields improved; 13.4 vs 12.1 months; P < .01). Role, social, and physical functioning were not affected by TTFields. Conclusions and Relevance The addition of TTFields to standard treatment with temozolomide for patients with glioblastoma results in improved survival without a negative influence on HRQoL except for more itchy skin, an expected consequence from the transducer arrays. Trial Registration clinicaltrials.gov Identifier: NCT00916409.
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Affiliation(s)
- Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew A Kanner
- Department of Neurosurgery, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Uri Weinberg
- Research and Development, Novocure, Haifa, Switzerland
| | - Sophie Taillibert
- Department of Neurology 2, Salpêtrière University Hospital, Assistance Public Hôpitaux de Paris, L'Université Pierre et Marie Curie University, Paris VI University, Paris, France
| | - Steven A Toms
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jerome Honnorat
- Department of Neuro-oncology, Hospices Civils de Lyon, University Claude Bernard Lyon, Lyon, France
| | - Thomas C Chen
- Department of Neurosurgery, University of Southern California, Los Angeles
| | - Jan Sroubek
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Carlos David
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts
| | - Ahmed Idbaih
- Department of Neurology 2, Salpêtrière University Hospital, Assistance Public Hôpitaux de Paris, L'Université Pierre et Marie Curie University, Paris VI University, Paris, France
| | - Jacob C Easaw
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, California
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, Korea
| | - Jordi Bruna
- Department of Neurology, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Andreas F Hottinger
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvonne Kew
- Clinical Neuro-Oncology Research Program, Department of Internal Medicine, Methodist Hospital, Houston, Texas
| | - Patrick Roth
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Rajiv Desai
- Neurosurgery and Spine Association, Maine Medical Center, Scarborough, Maine
| | - John L Villano
- Clinical Neuro-Oncology Research Program, Department of Internal Medicine, University of Kentucky Medical Center, Lexington
| | | | - Zvi Ram
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roger Stupp
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Northwestern Brain Tumor Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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15
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Milbury K, Li J, Weathers SP, Shih T, Malliaha S, Li Y, Cohen L. A research protocol for a pilot, randomized controlled trial designed to examine the feasibility of a dyadic versus individual yoga program for family caregivers of glioma patients undergoing radiotherapy. Pilot Feasibility Stud 2019; 5:95. [PMID: 31367462 PMCID: PMC6657047 DOI: 10.1186/s40814-019-0479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 07/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although the diagnosis and treatment of a primary brain tumor present unique challenges to patients and their family caregivers, evidence-based supportive care interventions are generally lacking. The primary aim of this research protocol is to determine the feasibility of implementing a dyadic yoga (DY) versus a caregiver yoga (CY) intervention or a wait-list control (WLC) group using a randomized controlled trial design. METHODS Seventy-five glioma patients undergoing radiotherapy and their family caregivers are randomized to the DY, CY, or a WLC group. Patient-caregiver dyads in the DY group and caregivers in the CY group receive 15 sessions (45 min each) over the course of patients' standard radiotherapy (6 weeks). Patients and caregivers in all groups complete baseline assessments of symptoms, quality of life (QOL), and health utilization outcomes prior to randomization. Follow-up assessments are performed 6 weeks and then again 3 months later. The primary outcome is feasibility (i.e., ≥ 50% of eligible dyads consent, ≥ 70% of enrolled dyads complete all assessments, and ≥ 50% of all practice sessions are attended). We will also perform primarily descriptive analyses of the self-reported outcomes (e.g., fatigue, overall QOL) and explore potential intervention moderators (e.g., performance status) to inform a larger future trial. CONCLUSION This trial will provide important information regarding the feasibility of a dyadic versus a caregiver yoga intervention regarding symptom, QOL, and health utilization outcomes in glioma patients and their caregivers. TRIAL REGISTRATION ClinicalTrials.gov NCT02481349.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030 USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Tina Shih
- Department of Health Services, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Smitha Malliaha
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030 USA
| | - Yisheng Li
- Department of Biostatics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Soysal Tomruk M, Göz E, Şengül Y, Kalemci O. Beyin tümör cerrahisi geçiren hastalarda gövde kontrolü fonksiyonel durumla ilişkilidir. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.439733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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17
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van der Meulen M, Dirven L, Habets EJJ, van den Bent MJ, Taphoorn MJB, Bromberg JEC. Cognitive functioning and health-related quality of life in patients with newly diagnosed primary CNS lymphoma: a systematic review. Lancet Oncol 2019; 19:e407-e418. [PMID: 30102235 DOI: 10.1016/s1470-2045(18)30356-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
Incidence of primary CNS lymphoma (PCNSL) is increasing, while prognosis is improving as treatments advance. However, declined cognitive functioning remains a major challenge in the treatment of PCNSL. This cognitive decline, in conjunction with other symptoms caused by the disease or its treatment, or both, can compromise health-related quality of life (HRQOL). The aim of this Review was to give a comprehensive overview on cognitive functioning and HRQOL for patients with PCNSL, including an evaluation of patient-related and treatment-related factors that can influence cognitive functioning and HRQOL. We reviewed the literature for studies on cognitive functioning and HRQOL in newly diagnosed adult patients with PCNSL using MEDLINE/PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, CINAHL EBSCO, and Google Scholar, up to Jan 4, 2018. Articles were selected using predetermined inclusion and exclusion criteria; 42 articles were eligible for inclusion. Findings show that the tumour itself has a great effect on cognitive functioning and HRQOL. Initially, induction chemotherapy results in improvement of cognition and HRQOL in most patients. In the long-term, the addition of whole-brain radiotherapy has a negative effect on cognitive functioning, but the magnitude of this effect is not always clinically relevant. HRQOL scores were worse compared with controls, and worse after combined chemotherapy and radiotherapy when compared with chemotherapy only, particularly in the long term. Therefore, combined chemotherapy and radiotherapy seems to have a negative effect on HRQOL and cognition in patients with PCNSL. Although prolonged progression-free survival is achieved with combined treatment, information on its effect on cognition and HRQOL should be included in clinical decision-making.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Esther J J Habets
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands; Department of Medical Psychology, Haaglanden Medical Center, The Hague, Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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18
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Fedorko S, Zweckberger K, Unterberg AW. Quality of life following surgical treatment of lesions within the pineal region. J Neurosurg 2019; 130:28-37. [PMID: 29498568 DOI: 10.3171/2017.7.jns17260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/06/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVEPineal region tumors are a rare and heterogeneous group of lesions. The optimal therapeutic approach is currently a topic of controversy, particularly in light of the potential operative risks and complications. The potential beneficial effects of surgery have already been described, but information about neurological outcome and, in particular, health-related quality of life (HRQOL) is still lacking in the literature. The aim of this study was to assess the therapeutic effect of resection of pineal region lesions, emphasizing grade of tumor resection, neurological outcome, quality of life, and the necessity of additional shunt procedures.METHODSThe authors performed a prospective study of HRQOL in 32 patients who had undergone surgical treatment of lesions in the pineal region (20 tumors and 12 cysts) between 2008 and 2014. All patients had at least 6 months of follow-up, with reexamination including standardized neurological assessment, an evaluation of dependency using the modified Rankin Scale, and an evaluation of HRQOL. The authors retrospectively examined patient charts and collected information regarding imaging studies, neurological status prior to surgery, surgical strategies used, any complications, and histological diagnoses.RESULTSIn this study, there was no surgery-associated mortality or major morbidity. Permanent minor morbidity was reported for 4 patients (13%). Comparing pre- and postoperative neurological symptoms, 75% of tumor patients had either complete resolution or improvement of preoperative symptoms; symptoms were unchanged in 10% of tumor patients and deteriorated in 15%. In patients with pineal cysts, long-term follow-up showed that 42% of patients were free of any symptoms and 58% experienced improvement of their preoperative symptoms. These outcomes were also reflected in the modified Rankin Scale scores, which demonstrated significant improvement following resection of pineal region lesions. Furthermore, significant improvements in HRQOL scores occurred in global health status, in all functional scales, and in pain, nausea and vomiting, fatigue, and insomnia (p < 0.0001). Moreover, a significant reduction in the necessity for permanent shunt procedures was observed after gross-total tumor resection compared with subtotal resection (p = 0.035) of pineal cysts.CONCLUSIONSDespite potential risks, (radical) surgery is a highly effective and safe treatment option for pineal region lesions and should be considered for the majority of patients.
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Milbury K, Li J, Weathers SP, Mallaiah S, Armstrong T, Li Y, Bruera E, Cohen L. Pilot randomized, controlled trial of a dyadic yoga program for glioma patients undergoing radiotherapy and their family caregivers. Neurooncol Pract 2018; 6:311-320. [PMID: 31386042 DOI: 10.1093/nop/npy052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background While the use of behavioral medicine in managing glioma patients' symptoms is not well studied, the high symptom burden in patients and their family caregivers is well established. We conducted a pilot randomized, controlled trial to examine the feasibility and preliminary efficacy of a dyadic yoga (DY) intervention as a supportive care strategy. Methods Glioma patients undergoing radiotherapy and their caregivers were randomized to a 12-session DY or waitlist control (WLC) group. Prior to radiotherapy and randomization, both groups completed measures of cancer-related symptoms (MD Anderson Symptom Inventory-Brain Tumor module), depressive symptoms (Center for Epidemiological Studies-Depression measure), fatigue (Brief Fatigue Inventory), and overall quality of life (QOL; Medical Outcomes Study 36-item short-form survey). Dyads were reassessed at the last day of radiotherapy. Results Twenty patients (mean age: 46 years, 50% female, 80% WHO grade IV and caregivers (mean age: 50 years, 70% female, 50% spouses) participated in the trial. A priori feasibility criteria were met regarding consent (70%), adherence (88%), and retention (95%) rates. Controlling for relevant covariates, change score analyses revealed clinically significant improvements for patients in the DY compared with the WLC group for overall cancer symptom severity (d = 0.96) and symptom interference (d = 0.74), depressive symptoms (d = 0.71), and mental QOL (d = 0.69). Caregivers in the DY group reported clinically significant improvements in depressive symptoms (d = 1.12), fatigue (d = 0.89), and mental QOL (d = 0.49) relative to those in the WLC group. Conclusion A DY intervention appears to be a feasible and beneficial symptom and QOL management strategy for glioma patients undergoing radiotherapy and their caregivers. An efficacy trial with a more stringent control group is warranted. Clinical Trial Number NCT02481349.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Smitha Mallaiah
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
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Abstract
Survivorship has become a significant topic within oncologic care. The tools and means by which the provision of survivorship care can be implemented and delivered are in development and are the focus of significant research oncology-wide. These tools and methods include innovations of survivorship care delivery, survivorship care plans, and improving communication among all stakeholders in an individual patient's care as the means to elevate health-related quality of life. The merits of these survivorship care provisions in the field of neuro-oncology and its patients' exigent need for more patient-centric care focused on living with their illness are discussed. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans, comprising a treatment summary and a follow-up plan, intended to facilitate patients' care after initial diagnosis and upfront treatment. Several cancer-specific survivorship care plans have been developed and endorsed by health care professional organizations and patient advocacy groups. A survivorship care plan specific for neuro-oncology has been collaboratively developed by a multidisciplinary and interprofessional committee; it is endorsed by the Society for Neuro-Oncology Guidelines Committee. It is available as open access for download from the Society for Neuro-Oncology website under "Resources": https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx. Survivorship care offers an opportunity to begin directly addressing the range of issues patients navigate throughout their illness trajectory, an oncology initiative to which neuro-oncology patients both need and deserve equitable access.
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Affiliation(s)
- Heather Leeper
- Department of Neurology, NorthShore University Health System, Evanston, Illinois
| | - Kathrin Milbury
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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21
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Depression and glioblastoma, complicated concomitant diseases: a systemic review of published literature. Neurosurg Rev 2018; 43:497-511. [PMID: 30094499 DOI: 10.1007/s10143-018-1017-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/09/2018] [Accepted: 07/26/2018] [Indexed: 01/27/2023]
Abstract
Glioblastoma multiforme (GBM) is the most common primary brain cancer. Depression is a common co-morbidity of this condition. Despite this common interaction, relatively little research has been performed on the development of GBM-associated depression. We performed a literary search of the PubMed database for articles published relating to GBM and depression. A total of 85 articles were identified with 46 meeting inclusion criteria. Depression significantly impacts care, decreasing medication compliance, and patient survival. Diagnostically, because depression and GBM share intricate neuro-connectivity in a way that effect functionality, these diseases can be mistaken for alternative psychological or pathological disorders, complicating care. Therapeutically, anti-depressants have anti-tumor properties; yet, some have been shown to interfere with GBM treatment. One reason for this is that the pathophysiological development of depression and GBM share several pathways including altered regulation of the 5-HT receptor, norepinephrine, and 3':5'-cyclic monophosphate. Over time, depression can persist after GBM treatment, affecting patient quality of life. Together, depression and GBM are complicated concomitant diseases. Clinicians must be aware of their co-existence. Because of overlapping molecular pathways involved in both diseases, careful medication selection is imperative to avoid potential adverse interactions. Since GBMs are the most common primary brain cancer, physicians dealing with this disease should be prepared for the development of depression as a potential sequela of this condition, given the related pathophysiology and the known poor outcomes.
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Jeon MS, Dhillon HM, Agar MR. Sleep disturbance of adults with a brain tumor and their family caregivers: a systematic review. Neuro Oncol 2018; 19:1035-1046. [PMID: 28340256 DOI: 10.1093/neuonc/nox019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The high incidence and psychophysiological morbidities of sleep disturbance in cancer have been increasingly recognized. Yet, more detailed understanding of sleep disturbance and options for management have been neglected areas in both clinical care and research. Brain tumor patients have been particularly overlooked. A systematic search of the literature from 1990 to 2015 was performed to review sleep disturbance in adults with primary or secondary brain tumor and their family caregivers. Fifty eligible studies were identified, of which 12 focused on sleep, 37 reported sleep items within a health-related quality of life measure and 1 reported caregivers' sleep. No sleep intervention has been developed or tested for brain tumor patients. Sleep disturbance and somnolence were frequently reported as the most severely rated symptoms within health-related quality of life across the disease course or treatments, along with fatigue. However, sleep-focused studies yielded inconsistent results in small samples of mostly benign brain tumors in long-term remission from total tumor resection. The research using standardized, multifaceted sleep assessments, particularly in patients with malignant brain tumor and caregivers who are undergoing treatment, is seriously lacking. A more systematic examination of sleep disturbance is warranted to inform the development of better symptom management programs in this population.
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Affiliation(s)
- Megan Soohwa Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Haryana M Dhillon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
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Ali FS, Hussain MR, Gutiérrez C, Demireva P, Ballester LY, Zhu JJ, Blanco A, Esquenazi Y. Cognitive disability in adult patients with brain tumors. Cancer Treat Rev 2018. [PMID: 29533821 DOI: 10.1016/j.ctrv.2018.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cognitive dysfunction is common among patients with intracranial tumors. Most cognitive deficits are subtle, lack specificity, may mimic depression or other neurological disorders and may be recognized in retrospect by the physician. In certain cases, distinguishing between tumor recurrence and cognitive deficits that arise as a consequence of the treatment becomes challenging. Late treatment effects have also become an area of focus as the overall survival and prognosis of patients with brain tumors increases. New data has highlighted the importance of less toxic adjuvant therapies owing to their positive impact on prognosis and quality of life. Various experimental therapies and genetic influences on individual sensitivity towards injury are promising steps towards a better management strategy for cognitive dysfunction. In this literature review, we discuss cognitive dysfunction as a manifestation of intracranial tumors, treatment modalities such as radiotherapy, chemotherapy, surgery and their impact on cognition and patients' quality of life. We also discuss management options for cognitive dysfunction and emerging therapies.
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Affiliation(s)
- Faisal S Ali
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States
| | - Maryam R Hussain
- Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Carolina Gutiérrez
- Department of Physical Medicine and Rehabilitation, Memorial Hermann, Houston, TX, United States
| | - Petya Demireva
- Department of Psychology/Neuropsychology, TIRR Memorial Hermann, Houston, TX, United States
| | - Leomar Y Ballester
- Department of Pathology, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jiguang-Jay Zhu
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States
| | - Angel Blanco
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States
| | - Yoshua Esquenazi
- The University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery and Mischer Neuroscience Institute, Houston, TX, United States.
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Weisman H, Fried I, Gilboa T, Bennett-Back O, Ekstein D, Shweiki M, Shoshan Y, Benifla M. Prevalence, Characteristics, and Long-Term Prognosis of Epilepsy Associated with Pediatric Brain Tumors. World Neurosurg 2017; 109:e594-e600. [PMID: 29054779 DOI: 10.1016/j.wneu.2017.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We investigated the prevalence, onset, characteristics, and long-term course of epilepsy disease in children who underwent surgical intervention for diagnosed brain tumors. METHODS We reviewed the medical records of children with diagnosed brain tumors who underwent surgery during 2004-2014 at the Hadassah Medical Center. All patients with epilepsy were invited to a clinical visit that included a neurologic examination. The primary outcome measures were neurologic status according to the Glasgow outcome score (GOS) and postoperative seizure outcome according to the Engel system. We compared clinical characteristics according to the timing of epilepsy onset. RESULTS The mean follow-up was 49 months. Of 128 patients included in the study, 44 (34%) had seizures; 23 (18%) developed epilepsy after surgery. Of the 30 patients with epilepsy who survived, 21 (70%) are in Engel class I and 13% Engel are in class II. Forty-five percent of the children are classified as GOS 5. Children who developed epilepsy after surgery were more likely to be in GOS 1-2 than were those who had seizures before surgery (P = 0.0173). Children with seizures were more likely to have cortical tumors and less likely to have tumors of the posterior fossa (P < 0.001). Children who underwent gross total resection were less likely to have epilepsy (P < 0.001). CONCLUSIONS We show a high incidence of epilepsy in the late course of pediatric brain tumor disease. In the long term, seizure outcome was excellent. However, postsurgical onset of epilepsy was associated with a less favorable neurologic outcome.
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Affiliation(s)
- Hadar Weisman
- Hematology-Oncology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Iris Fried
- Hematology-Oncology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Tal Gilboa
- Pediatric Neurology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Odeya Bennett-Back
- Pediatric Neurology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Dana Ekstein
- Neurology Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Moatasem Shweiki
- Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Yigal Shoshan
- Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Mony Benifla
- The Pediatric Neurosurgery Unit, Rambam Health Care Campus, Haifa, Israel.
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Atkinson TM, Stover AM, Storfer DF, Saracino RM, D'Agostino TA, Pergolizzi D, Matsoukas K, Li Y, Basch E. Patient-Reported Physical Function Measures in Cancer Clinical Trials. Epidemiol Rev 2017; 39:59-70. [PMID: 28453627 PMCID: PMC5858035 DOI: 10.1093/epirev/mxx008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/22/2022] Open
Abstract
Patient-reported outcomes (PROs) are increasingly used to monitor treatment-related symptoms and physical function decrements in cancer clinical trials. As more patients enter survivorship, it is important to capture PRO physical function throughout trials to help restore pretreatment levels of function. We completed a systematic review of PRO physical function measures used in cancer clinical trials and evaluated their psychometric properties on the basis of guidelines from the US Food and Drug Administration. Five databases were searched through October 2015: PubMed/MEDLINE, EMBASE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Health and Psychosocial Instruments, and Cochrane. From an initial total of 10,233 articles, we identified 108 trials that captured PRO physical function. Within these trials, approximately 67% used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and 25% used the Medical Outcomes Study Short Form 36. Both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and Medical Outcomes Study Short Form 36 instruments generically satisfy most Food and Drug Administration requirements, although neither sought direct patient input as part of item development. The newer Patient-Reported Outcomes Measurement Information System physical function short form may be a brief, viable alternative. Clinicians should carefully consider the psychometric properties of these measures when incorporating PRO instrumentation into clinical trial design to provide a more comprehensive understanding of patient function.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Angela M Stover
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel F Storfer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas A D'Agostino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Denise Pergolizzi
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantina Matsoukas
- Information Systems, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Randazzo D, Peters KB. Psychosocial distress and its effects on the health-related quality of life of primary brain tumor patients. CNS Oncol 2016; 5:241-9. [PMID: 27397796 PMCID: PMC6040083 DOI: 10.2217/cns-2016-0010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/05/2016] [Indexed: 11/21/2022] Open
Abstract
All cancer patients experience distress from the diagnosis, the effects of the disease or the treatment. Clinically significant distress decreases overall quality of life and the recognition of distress with prompt intervention is essential. The National Comprehensive Cancer Network distress thermometer (NCCN-DT) is a validated measuring tool that has been utilized in the primary brain tumor population to detect psychologic distress thereby provoking a referral process to the appropriate support system. Brain tumor patients commonly reported emotional and physical distress encompassing: fatigue, fears, memory and concentration and worry. More research is needed to identify the stressors of all primary brain tumor patients and their caretakers and integrate appropriate interventions to improve health-related quality of life in both groups.
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Affiliation(s)
- Dina Randazzo
- Department of Neurology, Duke University Medical Center, The Preston Robert Tisch Brain Tumor Center, Durham, NC 27710, USA
| | - Katherine B Peters
- Department of Neurology, Duke University Medical Center, The Preston Robert Tisch Brain Tumor Center, Durham, NC 27710, USA
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Asher A, Fu JB, Bailey C, Hughes JK. Fatigue among patients with brain tumors. CNS Oncol 2016; 5:91-100. [PMID: 26987038 PMCID: PMC6047436 DOI: 10.2217/cns-2015-0008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
Abstract
Fatigue is a ubiquitous and an extremely distressing symptom among patients with brain tumors (BT), particularly those with high-grade gliomas. The pathophysiology of cancer-related fatigue (CRF) in the context of patients with BT is multifactorial and complex, involving biological, behavioral, medical and social factors. The etiology of CRF in the general oncology population is pointing to the role of inflammatory cytokines as a key factor in the genesis of CRF, but this research is currently limited in the setting of BT. CRF should be screened, assessed and managed according to clinical practice guidelines. Fatigue has recently emerged as a strong, independent prognostic factor for survival that provides incremental prognostic value to the traditional markers of prognosis in recurrent high-grade gliomas. Therefore, strategies to treat fatigue warrant investigation, not only to improve the QOL of a group of patients with often limited life expectancy, but also possibly to optimize survival.
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Affiliation(s)
- Arash Asher
- Cancer Survivorship & Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Assistant Clinical Professor, Health Sciences, UCLA, 8700 Beverly Boulevard, AC 1109 Los Angeles, 90048, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030, USA
| | - Charlotte Bailey
- Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Jennifer K Hughes
- Department of Rehabilitation, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Dirven L, Sizoo EM, Taphoorn MJB. Anaplastic gliomas: end-of-life care recommendations. CNS Oncol 2015; 4:357-65. [PMID: 26509292 DOI: 10.2217/cns.15.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite multimodal antitumor treatment, all patients with an anaplastic glioma will be confronted with incurability in due course and enter the end-of-life (EOL) phase; the period when the patients' condition declines and tumor-directed treatment is no longer effective. Although palliative care is important in all stages of the disease, it is of utmost importance in the EOL phase. The main goal of palliative care is to improve or maintain the quality of life of the patients and their relatives through the prevention and relief of suffering. This review focuses on different aspects of the EOL phase (symptoms and signs, EOL decision-making, advance care planning, organization of care and caregiver burden) and will provide recommendations to optimize palliative care.
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Affiliation(s)
- Linda Dirven
- VU University Medical Center, Department of Neurology, POBOX 7057, 1007 MB Amsterdam, The Netherlands
| | - Eefje M Sizoo
- VU University Medical Center, Department of Neurology, POBOX 7057, 1007 MB Amsterdam, The Netherlands
| | - Martin J B Taphoorn
- VU University Medical Center, Department of Neurology, POBOX 7057, 1007 MB Amsterdam, The Netherlands.,Medical Center Haaglanden, Department of Neurology, The Hague, The Netherlands
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Baker PD, Bambrough J, Fox JRE, Kyle SD. Health-related quality of life and psychological functioning in patients with primary malignant brain tumors: a systematic review of clinical, demographic and mental health factors. Neurooncol Pract 2015; 3:211-221. [PMID: 31386034 DOI: 10.1093/nop/npv042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Indexed: 12/18/2022] Open
Abstract
Background The impact of primary malignant brain tumors on patient quality of life and psychological functioning is poorly understood, limiting the development of an evidence base for supportive interventions. We conducted a thorough systematic review and quality appraisal of the relevant literature to identify correlates of health-related quality of life (HRQoL) and psychological functioning (depression, anxiety and distress) in adults with primary malignant brain tumors. Method Twenty-three articles met predefined inclusion criteria from a pool of peer-reviewed literature published between January 1984 and July 2015 (N = 2407). Methodological quality of included studies was assessed using an adapted version of the Newcastle-Ottawa Scale. Results The overall methodological quality of the literature was moderate. Factors relating consistently with HRQoL and/or psychological functioning were cognitive impairment, corticosteroid use, current or previous mental health difficulties, fatigue, functional impairment, performance status and motor impairment. Conclusions Practitioners should remain alert to the presence of these factors as they may indicate patients at greater risk of poor HRQoL and psychological functioning. Attention should be directed towards improving patients' psychological functioning and maximizing functional independence to promote HRQoL. We outline several areas of future research with emphasis on improved methodological rigor.
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Affiliation(s)
- Paul D Baker
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
| | - Jacki Bambrough
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
| | - John R E Fox
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
| | - Simon D Kyle
- Section for Clinical and Health Psychology, University of Manchester, Manchester, UK (P.D.B.); Department of Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK (J.B.); Department of Psychology, Royal Holloway, University of London, Surrey, UK (J.R.E.F.); Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK (J.R.E.F.); Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (S.D.K.)
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Taphoorn MJ, Henriksson R, Bottomley A, Cloughesy T, Wick W, Mason WP, Saran F, Nishikawa R, Hilton M, Theodore-Oklota C, Ravelo A, Chinot OL. Health-Related Quality of Life in a Randomized Phase III Study of Bevacizumab, Temozolomide, and Radiotherapy in Newly Diagnosed Glioblastoma. J Clin Oncol 2015; 33:2166-75. [DOI: 10.1200/jco.2014.60.3217] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose As glioblastoma progresses, patients experience a decline in health-related quality of life (HRQoL). Delaying this decline is an important treatment goal. In newly diagnosed glioblastoma, progression-free survival was prolonged when bevacizumab was added to radiotherapy plus temozolomide (RT/TMZ) versus placebo plus RT/TMZ (phase III AVAglio study; hazard ratio, 0.64; 95% CI, 0.55 to 0.74; P < .001). To ensure that addition of bevacizumab to standard-of-care therapy was not associated with HRQoL detriment, HRQoL assessment was a secondary objective. Patients and Methods Patients completed European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BN20 at each tumor assessment (Appendix Table A1 , online only). Raw scores were converted to a 100-point scale and mean changes from baseline scores were evaluated (stable: < 10-point change; clinically relevant deterioration/improvement: ≥ 10-point change). Deterioration-free survival was the time to deterioration/progression/death; time to deterioration was the time to deterioration/death. Results Most evaluable patients who had not progressed (> 74%) completed all HRQoL assessments for at least 1 year of treatment, and almost all completed at least one HRQoL assessment at baseline (98.3% and 97.6%, bevacizumab and placebo arms, respectively). Mean changes from baseline did not reach a clinically relevant difference between arms for most items. HRQoL declined at progression in both arms. The addition of bevacizumab to RT/TMZ resulted in statistically longer (P < .001) deterioration-free survival across all items. Time to deterioration was not statistically longer in the placebo plus RT/TMZ arm (v bevacizumab) for any HRQoL item. Conclusion The addition of bevacizumab to standard-of-care treatment for newly diagnosed glioblastoma had no impact on HRQoL during the progression-free period.
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Affiliation(s)
- Martin J.B. Taphoorn
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Roger Henriksson
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Andrew Bottomley
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Timothy Cloughesy
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Wolfgang Wick
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Warren P. Mason
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Frank Saran
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Ryo Nishikawa
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Magalie Hilton
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Christina Theodore-Oklota
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Arliene Ravelo
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
| | - Olivier L. Chinot
- Martin J.B. Taphoorn, Medical Center Haaglanden, the Hague, and VU University Medical Center, Amsterdam, the Netherlands; Roger Henriksson, Cancer Center Stockholm Gotland, Karolinska, Stockholm, and Umeå University, Umeå, Sweden; Andrew Bottomley, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Timothy Cloughesy, University of California, Los Angeles, Los Angeles; Christina Theodore-Oklota and Arliene Ravelo, Genentech, South San Francisco, CA; Wolfgang Wick, University
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Amidei C, Kushner DS. Clinical implications of motor deficits related to brain tumors †. Neurooncol Pract 2015; 2:179-184. [PMID: 31386054 DOI: 10.1093/nop/npv017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Indexed: 11/14/2022] Open
Abstract
Motor deficits, including unilateral or bilateral weakness, plegia, ataxia, spasticity, and loss of complex movement execution, can occur during any brain tumor illness. Tumor location, treatment effects, and medications contribute to these deficits. Motor dysfunction has been associated with significant deterioration in health-related quality of life in patients with primary and metastatic brain tumors. Significant decrease in median overall survival has been reported in patients with motor deficits, although the reasons for this are unclear. Motor deficits, particularly gait impairment, contribute to significant symptom burden at end of life, and are the most common reasons for initiation of hospice care. Interventions must focus on prevention and amelioration of motor dysfunction throughout the disease course in order to preserve quality of life. The impact of exercise in prolonging survival and improving quality of life requires further study.
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Affiliation(s)
- Christina Amidei
- Department of Neurology and Rehabilitation, University of Illinois, 912 S. Wood Street, MC 796, Chicago, Illinois 60612 (C.A.); Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, Florida 33136 (D.K.)
| | - David S Kushner
- Department of Neurology and Rehabilitation, University of Illinois, 912 S. Wood Street, MC 796, Chicago, Illinois 60612 (C.A.); Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, Florida 33136 (D.K.)
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Aprile I, Chiesa S, Padua L, Di Blasi C, Arezzo MF, Valentini V, Di Stasio E, Balducci M. Occurrence and predictors of the fatigue in high-grade glioma patients. Neurol Sci 2015; 36:1363-9. [PMID: 25698127 DOI: 10.1007/s10072-015-2111-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/11/2015] [Indexed: 11/12/2022]
Abstract
A better knowledge of the fatigue could be of the greatest importance for the high-grade glioma (HGG) patients, who are a unique and vulnerable population. The aim of this study was to evaluate the occurrence and the predictors of the fatigue in HGG patients, using a specific fatigue scale. The study was designed as a cross-sectional study. The study population included sixty-seven consecutive outpatients with HGG. We used these measures: Brief Fatigue Inventory, Karnofsky Performance Scale, Functional Independence Measure, Brief Psychiatric Rating Scale and Psychological Distress Inventory and SF-36, EORTC QLQ-30 and EORTC QLQ-BN20 for quality of life (QoL). Sixteen out of sixty-seven (23.9 %) patients were affected by Anaplastic Astrocytoma and 51/67 (76.1 %) by Glioblastoma Multiforme. About one-third (36.2 %) of patients had a clinically relevant fatigue (Brief Fatigue Inventory ≥3). In regression analysis, physical and mental aspects of QoL were statistically significant related with fatigue (p < 0.01 and p < 0.02, respectively). Our data underlined the relevant occurrence of fatigue in HGG patients and support the development of further studies exploring a tailored rehabilitation program.
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Affiliation(s)
- Irene Aprile
- Don Carlo Gnocchi Onlus Foundation, Via Maresciallo Caviglia 30, 00194, Rome, Italy,
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Taphoorn MJB, Bottomley A. Health-related quality of life and symptom research in glioblastoma multiforme patients. Expert Rev Pharmacoecon Outcomes Res 2014; 5:763-74. [DOI: 10.1586/14737167.5.6.763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sizoo EM, Grisold W, Taphoorn MJB. Neurologic aspects of palliative care: the end of life setting. HANDBOOK OF CLINICAL NEUROLOGY 2014; 121:1219-1225. [PMID: 24365413 DOI: 10.1016/b978-0-7020-4088-7.00081-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
As there are, to date, few curative treatment options for many neurologic diseases, end of life (EOL) care is an important aspect of the treatment of neurologic patients. In the EOL phase, treatment should be aimed at relieving symptoms, maintaining quality of life, and facilitating a peaceful and dignified way of dying. Common signs and symptoms in the EOL phase of neurologic patients are raised intracranial pressure, seizures, confusion, cognitive deficits, and impaired motor function. Supportive treatment of these symptoms (such as analgesic drugs, dexamethasone, antiepileptic and neuroleptic drugs) is of major importance to maintain quality of life as long as possible. Another key aspect of EOL care is EOL decision making, such as withholding or withdrawing life-sustaining treatment, and palliative sedation. The main goal of EOL decision making is the prevention and relief of suffering, even if this might hasten death. Especially in advanced stages of many neurologic diseases, confusion, cognitive deficits, communication deficits, and decreasing levels of consciousness may impair the competence of patients to participate in EOL decision making. Given that patient autonomy is increasingly essential, advance care planning (ACP) at an early stage of the disease should be considered.
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Affiliation(s)
- Eefje M Sizoo
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josep Hospital, Vienna, Austria
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Le Reste PJ, Henaux PL, Morandi X, Carsin-Nicol B, Brassier G, Riffaud L. Sporadic intracranial haemangioblastomas: surgical outcome in a single institution series. Acta Neurochir (Wien) 2013; 155:1003-9; discussion 1009. [PMID: 23558723 DOI: 10.1007/s00701-013-1681-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Haemangioblastomas are benign vascular tumours that may appear sporadically or in von Hippel-Lindau disease. Despite their higher incidence, sporadic haemangioblastomas have been less studied than syndromic ones. In this article, we evaluate the specific features, outcome and quality of life of patients with intracranial sporadic haemangioblastomas (ISHs) operated on in our institution. METHODS Between 1998 and 2010, 38 patients harbouring 38 ISHs were operated on in our department. Their clinical, biological, radiological and surgical features were retrospectively reviewed. All patients were contacted for a quality-of-life (QOL) survey assessed by the Short Form 36 questionnaire (SF36). The mean duration of follow-up was 40 months (13-108 months). RESULTS ISH represented 0.9 % of primary intracranial neoplasms treated in our centre during this period. Patients comprised 23 men and 15 women with a mean age of 47 years. None had polycythaemia. Cerebellar locations accounted for 79 % of ISHs, and brainstem ISH with involvement of the floor of the fourth ventricle represented 11 % of ISHs. At last follow-up, two patients harbouring solid medulla oblongata haemangioblastoma had died following severe bulbar syndrome and five patients had died of unrelated causes. One patient had multiple surgeries for three recurrences. Tumoral control was achieved in all cases at last follow-up. Results of the SF-36 questionnaire were as follows: median physical functioning score 100 (range 0-100), median physical problems score 100 (range 0-100), median bodily pain score 100 (range 45-100), median social functioning score 100 (range 25-100), median general mental health score 84 (range 40-92), median emotional problems score 100 (range 0-100), median vitality score 70 (range 35-80) and median general health perceptions score 70 (range 35-100). Mean QOL scores were similar to the general healthy population. CONCLUSION Surgery of ISH provides good QOL and tumoral control except for those located in the medulla oblongata. We recommend considering a careful multimodal therapeutic approach, including radiosurgery for these specific locations.
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Affiliation(s)
- Pierre-Jean Le Reste
- Department of Neurosurgery, Pontchaillou University Hospital, 35033, Rennes cedex 09, France
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Cahill J, LoBiondo-Wood G, Bergstrom N, Armstrong T. Brain Tumor Symptoms as Antecedents to Uncertainty: An Integrative Review. J Nurs Scholarsh 2012; 44:145-55. [DOI: 10.1111/j.1547-5069.2012.01445.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Taphoorn MJB, Klein M. Evaluation of cognitive functions and quality of life. HANDBOOK OF CLINICAL NEUROLOGY 2012; 104:173-83. [PMID: 22230444 DOI: 10.1016/b978-0-444-52138-5.00014-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Martin J B Taphoorn
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
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Heinzel A, Stock S, Langen KJ, Müller D. Cost-effectiveness analysis of amino acid PET-guided surgery for supratentorial high-grade gliomas. J Nucl Med 2012; 53:552-8. [PMID: 22419752 DOI: 10.2967/jnumed.111.097352] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED High-grade gliomas are brain tumors associated with a devastating prognosis. Recent studies have indicated that the combined use of amino acid PET and MRI is superior to MRI alone to plan the surgical resection of high-grade gliomas. The aim of the study was to analyze the cost-effectiveness of the use of amino acid PET for the surgical resection of high-grade gliomas, compared with MRI alone, from the perspective of the national health insurance in Germany. METHODS A decision-tree model was set up to compare 2 strategies: the use of MRI alone and the combined use of MRI and PET for surgical resection of high-grade gliomas. For the analysis, 2 scenarios were calculated: a baseline scenario and a more expensive scenario, accounting for disease severity. To test the robustness of the results, probabilistic sensitivity analyses using Monte Carlo simulation were calculated. RESULTS Compared with MRI alone, the combined use of MRI and PET showed an incremental cost-effectiveness ratio of €2,948 (€1 ~ U.S.$1.3)per life-year gained for the baseline scenario and an incremental cost-effectiveness ratio of €4,105 per life-year gained for the admissible-charge-rate scenario. In the probabilistic sensitivity analysis in about 60% of the iterations, the combined use of PET and MRI was superior to MRI alone when assuming a willingness-to-pay threshold of €30,000. CONCLUSION The model indicates that the combined use of MRI and PET may be cost-effective. The results of this analysis have to be considered carefully because there was only limited empiric evidence for several input parameters.
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Affiliation(s)
- Alexander Heinzel
- Department of Nuclear Medicine of the Heinrich-Heine University of Duesseldorf at the Research Centre Juelich, Juelich, Germany.
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Affiliation(s)
- Marta Penas-Prado
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abergel A, Fliss DM, Margalit N, Gil Z. A prospective evaluation of short-term health-related quality of life in patients undergoing anterior skull base surgery. Skull Base 2011; 20:27-33. [PMID: 20592855 DOI: 10.1055/s-0029-1242982] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We evaluated the health-related quality of life (QOL) of patients undergoing anterior skull base tumor resection. The Anterior Skull Base Surgery QOL questionnaire, a disease-specific multidimensional instrument dedicated to this population, was used to collect and prospectively analyze demographic, medical, and QOL data on 48 patients. Thirty-nine patients completed the questionnaire preoperatively and at 6 and 12 months postoperatively. Seventeen patients (44%) had malignant histology and 22 (56%) had benign tumors. The overall QOL score decreased significantly at 6 months postoperatively (p < 0.05) and improved significantly at 12 months postoperatively (p < 0.04). The emotional domain improved significantly at 12 months postoperatively compared with the preoperative scores (p < 0.03). Patients with malignant tumors had lower scores at 6 months postoperatively compared with patients with benign lesions (p < 0.002), although the scores for both groups at 12 months postoperatively were similar. Adjuvant radiation therapy was associated with a poor QOL (p < 0.005). The results of this prospective study show that the overall deteriorated QOL of patients after anterior skull base tumor resection returns to baseline by 1 year after surgery. Histology and radiotherapy are significant predictors of health-related QOL in this population.
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Affiliation(s)
- Abraham Abergel
- Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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De Benedictis A, Duffau H. Brain Hodotopy: From Esoteric Concept to Practical Surgical Applications. Neurosurgery 2011; 68:1709-23; discussion 1723. [DOI: 10.1227/neu.0b013e3182124690] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AbstractBACKGROUND:The traditional neurosurgical approach to cerebral lesions is based on the classic view of a rigid brain organization in fixed “eloquent” areas. However, this method is brought into discussion by the conceptual and methodological advances in neurosciences that provide a more dynamic representation of the anatomo-functional distribution of the human central nervous system (CNS).OBJECTIVE AND METHODS:We review the relevant literature concerning the main features of the modern CNS representation and their implications in neurosurgical practice.RESULTS:The CNS is an integrated, wide, plastic network made up of cortical functional epicenters, “topic organization,” connected by both short-local and large-scale white matter fibers, ie, “hodological organization.” According to this model, called hodotopic, brain function results from parallel streams of information dynamically modulated within an interactive, multimodal, and widely distributed circuit. The application of this framework, which can be studied by combining preoperative, intraoperative, and postoperative mapping techniques, enables the neurosurgeon exploration of the individual anatomo-functional architecture, including neurocognitive and emotional aspects. Thus, it is possible to adapt the surgical approach specifically to each patient and to each lesion according to the individual organization. Several experiences demonstrate the possibility of removing regions traditionally considered inoperable without inducing permanent deficits and the potential use of these areas as a safe passage to deeper territories.CONCLUSION:We advocate the more systematic integration of a hodotopical view of the CNS to improve the surgical indications and planning for brain lesions, with the goal of optimizing both the extent of resection and functional outcome.
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Affiliation(s)
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France
- Institute of Neuroscience of Montpellier, INSERM U1051, Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
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Abstract
BACKGROUND There is no consensus on the best management of adults with presumed low grade glioma (LGG). Studies have suggested uncertainty and anxiety associated with a wait and see approach contribute to reduced quality of life. This study aims to explore the impact of a diagnosis of LGG, to address concerns regarding the uncertainty of the diagnosis and the role of wait and see from the patient's perspective. METHODS Qualitative research methodology was used. A semi-structured interview was conducted with 24 patients with imaging evidence of LGG but no prior intervention. All patients had been followed for at least one year prior to interview. Verbatim transcripts were subjected to thematic analysis. RESULTS The median age of participants was 47 (range 21-82) and the median duration of follow-up 37 months (range 12-156 months). Fifty percent presented with seizures. Five overarching themes emerged from the data; 1) patients experience initial devastation followed by acceptance and low anxiety; 2) absence of symptoms mitigates anxiety concerning the possibility of progression; 3) patients would prefer to defer surgery until there is progression or a change in their quality of life; 4) anxiety is reduced by trust in the physician; 5) quality of life is not affected by the diagnosis, as fear of morbidity from intervention is greater than the fear of uncertainty. CONCLUSIONS The wait and see approach does not contribute to anxiety or reduction in quality of life in patients with LGG.
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Cheng JX, Liu BL, Zhang X, Zhang YQ, Lin W, Wang R, Zhang YQ, Zhang HY, Xie L, Huo JL. The validation of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) in pre-operative patients with brain tumor in China. BMC Med Res Methodol 2011; 11:56. [PMID: 21513533 PMCID: PMC3112193 DOI: 10.1186/1471-2288-11-56] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 04/22/2011] [Indexed: 11/12/2022] Open
Abstract
Background Health related quality of life (HRQOL) has increasingly emphasized on cancer patients. The psychometric properties of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30, version 3.0) in brain tumor patients wasn't proven, and there was no baseline HRQOL in brain tumor patients prior to surgery. Methods The questionnaire EORTC QLQ-C30 (version 3.0) was administered at three time points: T1, the first or the second day that patients were hospitalized after the brain tumor suspected or diagnosed by MRI or CT; T2, 1 to 2 days after T1, (T1 and T2 were both before surgery); T3, the day before discharge. Clinical variables included disease histologic types, cognitive function, and Karnofsky Performance Status. Results Cronbach's alpha coefficients for multi-item scales were greater than .70 and multitrait scaling analysis showed that most of the item-scale correlation coefficients met the standards of convergent and discriminant validity, except for the cognitive functioning scale. All scales and items exhibited construct validity. Score changes over peri-operation were observed in physical and role functioning scales. Compared with mixed cancer patients assessed after surgery but before adjuvant treatment, brain tumor patients assessed pre-surgery presented better function and fewer symptoms. Conclusions The standard Chinese version of the EORTC QLQ-C30 was overall a valid instrument to assess HRQOL in brain tumor patients in China. The baseline HRQOL in brain tumor patients pre-surgery was better than that in mixed cancer patients post-surgery. Future study should modify cognitive functioning scale and examine test-retest reliability and response validity.
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Affiliation(s)
- Jin-xiang Cheng
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, People's Republic of China
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Armstrong TS, Cron SG, Bolanos EV, Gilbert MR, Kang DH. Risk factors for fatigue severity in primary brain tumor patients. Cancer 2010; 116:2707-15. [PMID: 20235192 DOI: 10.1002/cncr.25018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In addition to neurologic symptoms, fatigue is commonly reported in patients with primary brain tumors during radiation therapy and in long-term survivors of low-grade brain tumors. Other factors have not been explored. The aim of this study was to identify demographic and clinical factors that predict fatigue severity and to evaluate the association of fatigue with other symptoms throughout the disease trajectory. METHODS Two hundred one patients with primary brain tumors completed the M. D. Anderson Symptom Inventory-Brain Tumor Module and a demographic checklist. Clinical data, including treatment, tumor grade, and performance status, were also collected. Correlations among fatigue and other recorded symptoms were evaluated. Logistic regression modeling was performed to evaluate factors associated with fatigue severity. RESULTS Fatigue severity was associated with symptoms including pain, drowsiness, distress, difficulty sleeping, and weakness as well as overall symptom severity and interference. Poor performance status (Karnofsky scale) (odds ratio [OR], 5.73; P = .001), female sex (OR, 2.48; P = .005), and disease status (OR, 2.20; P = .013) were the strongest predictors of fatigue. Severity of fatigue for women was primarily predicted by disease status (OR, 3.33; P = .01) For men, antidepressant use (OR, 4.43; P = .013) in addition to opioids (OR, 3.46; P = .017) and performance status (OR, 12.47; P = .0001) predicted fatigue severity. CONCLUSIONS Fatigue should not be considered a solitary symptom with 1 root cause, but a complex symptom related to the severity of other symptoms and potentially having various etiologies. Future studies should consider these factors in planning interventions and assessing response.
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Affiliation(s)
- Terri S Armstrong
- Department of Integrative Nursing Care, School of Nursing, University of Texas Health Science Center, Houston, Texas 77030, USA.
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Cheng JX, Liu BL, Zhang X, Lin W, Zhang YQ, Liu WP, Zhang JN, Lin H, Wang R, Yin H. Health-related quality of life in glioma patients in China. BMC Cancer 2010; 10:305. [PMID: 20565883 PMCID: PMC2910687 DOI: 10.1186/1471-2407-10-305] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 06/18/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) has been increasingly emphasized in cancer patients. There are no reports comparing baseline HRQOL of different subgroups of glioma patients prior to surgery. METHODS HRQOL assessments by the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30, version 3.0), the Mini-Mental State Examination and Karnofsky Performance Status were obtained from glioma patients prior to surgery. RESULTS Ninety-two pathologically confirmed glioma patients were recruited. There were 84.8% patients with emotional impairment, 75% with social and cognitive impairment, 70.7% with physical impairment, and 50% with role impairment. Eighty-two percent of patients reported fatigue symptoms, 72.8% reported pain, 50% reported appetite loss, 39.1% reported insomnia, and 36.9% reported nausea/vomiting, whereas other symptoms (dyspnea, diarrhea, constipation) in the QLQ-C30 were reported by fewer than 30% of patients. Fatigue and pain symptoms and all "functioning" scales were strongly correlated with global health status/quality of life (QoL). Fatigue was strongly related to all functioning scales, pain, appetite loss, and global health status/QoL. No difference in baseline HRQOL prior to surgery was reported between females and males, among different lesion locations, or between normal- and abnormal-cognition subgroups of glioma patients. Age, KPS, WHO grade, and tumor recurrence significantly affected HRQOL in glioma patients. CONCLUSIONS These data provided the baseline HRQOL in glioma patients prior to surgery in China. Most pre-surgery glioma patients indicated emotional, social, cognitive, physical, and role impairment. Fatigue, pain, appetite loss, insomnia, and nausea/vomiting were common in these patients. The fatigue and pain symptoms and all types of functioning strongly affected global health status/QoL. Old age, worse performance status, WHO grade IV and tumor recurrence had deleterious effects on HRQOL.
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Affiliation(s)
- Jin-xiang Cheng
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Taphoorn MJB, Sizoo EM, Bottomley A. Review on quality of life issues in patients with primary brain tumors. Oncologist 2010; 15:618-26. [PMID: 20507891 DOI: 10.1634/theoncologist.2009-0291] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Health-related quality of life (HRQOL) has become an important outcome measure in clinical trials in primary brain tumor (i.e., glioma) patients, because they have an incurable disease. HRQOL is assessed using self-reported, validated questionnaires, addressing physical, psychological, emotional, and social issues. In addition to generic HRQOL instruments, disease-specific questionnaires have been developed, including for brain tumor patients. For the analysis and interpretation of HRQOL measurements, low compliance and missing data are methodological challenges. HRQOL in glioma patients may be negatively affected by the disease itself as well as by side effects of treatment. But treatment with surgery, radiotherapy, and chemotherapy may improve patient functioning and HRQOL, in addition to extending survival. Although HRQOL has prognostic significance in brain tumor patients, it is not superior to well-known clinical parameters, such as age and performance status. In clinical practice, assessing HRQOL may be helpful in the communication between doctor and patient and may facilitate treatment decisions.
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Affiliation(s)
- Martin J B Taphoorn
- VU University Medical Center, Department of Neurology, Amsterdam, The Netherlands.
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Franceschi E, Tosoni A, Bartolini S, Mazzocchi V, Fioravanti A, Brandes AA. Treatment options for recurrent glioblastoma: pitfalls and future trends. Expert Rev Anticancer Ther 2009; 9:613-9. [PMID: 19445578 DOI: 10.1586/era.09.23] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Standard treatment with temozolomide and radiotherapy for patients with newly diagnosed glioblastoma has increased the median overall survival and, more importantly, the 2-year survival rate of patients. However, as yet, no investigations have been conducted to define effective strategies against recurrence, which occurs in most patients following combined radiotherapy/temozolomide treatment. Furthermore, in recent years, new issues have emerged regarding the evaluation of disease response, and also with the identification of patterns such as pseudoprogression, frequently indistinguishable from real disease progression. New therapeutic strategies, such as targeted therapies and anti-angiogenic treatments that appear promising with regard to improving the results at the time of recurrence are discussed.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy.
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Ownsworth T, Hawkes A, Steginga S, Walker D, Shum D. A biopsychosocial perspective on adjustment and quality of life following brain tumor: A systematic evaluation of the literature. Disabil Rehabil 2009; 31:1038-55. [DOI: 10.1080/09638280802509538] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Macdonald DR, Kiebert G, Prados M, Yung A, Olson J. Benefit of Temozolomide Compared to Procarbazine in Treatment of Glioblastoma Multiforme at First Relapse: Effect on Neurological Functioning, Performance Status, and Health Related Quality of Life. Cancer Invest 2009. [DOI: 10.1081/cnv-50453] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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