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Boele F, Rosenlund L, Nordentoft S, Melhuish S, Nicklin E, Rydén I, Williamson A, Donders-Kamphuis M, Preusser M, Le Rhun E, Kiesel B, Minniti G, Furtner J, Dirven L, Taphoorn M, Galldiks N, Rudà R, Chalmers A, Short SC, Piil K. Inequalities in access to neuro-oncology supportive care and rehabilitation: A survey of healthcare professionals' perspectives. Neurooncol Pract 2024; 11:484-493. [PMID: 39006521 PMCID: PMC11241368 DOI: 10.1093/nop/npae023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Background Neuro-oncology patients and caregivers should have equitable access to rehabilitation, supportive-, and palliative care. To investigate existing issues and potential solutions, we surveyed neuro-oncology professionals to explore current barriers and facilitators to screening patients' needs and referral to services. Methods Members of the European Association of Neuro-Oncology and the European Organisation for Research and Treatment of Cancer Brain Tumor Group (EORTC-BTG) were invited to complete a 39-item online questionnaire covering the availability of services, screening, and referral practice. Responses were analyzed descriptively; associations between sociodemographic/clinical variables and screening/referral practice were explored. Results In total, 103 participants completed the survey (67% women and 57% medical doctors). Fifteen professions from 23 countries were represented. Various rehabilitation, supportive-, and palliative care services were available yet rated "inadequate" by 21-37% of participants. Most respondents with a clinical role (n = 94) declare to screen (78%) and to refer (83%) their patients routinely for physical/cognitive/emotional issues. Survey completers (n = 103) indicated the main reasons for not screening/referring were (1) lack of suitable referral options (50%); (2) shortage of healthcare professionals (48%); and (3) long waiting lists (42%). To improve service provision, respondents suggested there is a need for education about neuro-oncology-specific issues (75%), improving the availability of services (65%) and staff (64%), developing international guidelines (64%), and strengthening the existing evidence-base for rehabilitation (60%). Conclusions Detecting and managing neuro-oncology patients' and caregivers' rehabilitation, supportive,- and palliative care needs can be improved. Better international collaboration can help address healthcare disparities.
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Affiliation(s)
- Florien Boele
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lena Rosenlund
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden
| | - Sara Nordentoft
- Department of Neurosurgery, Neurocentre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sara Melhuish
- Speech and Language Therapy Department, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Emma Nicklin
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
| | - Isabelle Rydén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Marike Donders-Kamphuis
- Department of Neurosurgery, Haaglanden Medisch Centrum, The Hague, The Netherlands
- Department of Neurosurgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University, Vienna, Austria
| | - Emilie Le Rhun
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Barbara Kiesel
- Department of Neurosurgery, Medical UniversityVienna, Austria
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology & Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Julia Furtner
- Faculty of Medicine and Dentistry, Research Center for Medical Image Analysis and Artificial Intelligence (MIAAI), Danube Private University, Krems, Austria
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Norbert Galldiks
- Department of Radiological Sciences, Oncology and Anatomical Pathology & Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Susan C Short
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karin Piil
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
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2
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Zanotto A, Glover RN, Zanotto T, Boele FW. Rehabilitation in People Living with Glioblastoma: A Narrative Review of the Literature. Cancers (Basel) 2024; 16:1699. [PMID: 38730651 PMCID: PMC11083409 DOI: 10.3390/cancers16091699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Glioblastoma is the most common primary malignant brain tumor. While preliminary data point to the positive effects of rehabilitation for patients with glioblastoma, there are unique challenges for clinicians working with this population, including limited life expectancy and/or rapid neurological deterioration. The aim of this article is to review the literature on rehabilitation of adults with glioblastoma, including the feasibility of interventions, their effectiveness, as well as the current clinical practice. The reviewed literature suggests that rehabilitation has been found beneficial for improving the functional prognosis and quality of life of adults with glioblastoma and is desired by patients. We summarize the qualitative evidence regarding healthcare professionals' and patients' perspectives on the use of supportive care services. We conclude there is a need for the design of effective rehabilitation programs for patients with glioblastoma, as well as for the development of glioblastoma-specific clinical guidelines for rehabilitation practitioners.
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Affiliation(s)
- Anna Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; (R.N.G.); (T.Z.)
| | - Rebecca N. Glover
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; (R.N.G.); (T.Z.)
| | - Tobia Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; (R.N.G.); (T.Z.)
| | - Florien W. Boele
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds LS2 9JT, UK
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
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3
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Engelhardt M, Schneider H, Reuther J, Grittner U, Vajkoczy P, Picht T, Rosenstock T. Low-frequency repetitive transcranial magnetic stimulation in patients with motor deficits after brain tumor resection: a randomized, double-blind, sham-controlled trial. Front Oncol 2024; 14:1368924. [PMID: 38737898 PMCID: PMC11082392 DOI: 10.3389/fonc.2024.1368924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Objective Surgical resection of motor eloquent tumors poses the risk of causing postoperative motor deficits which leads to reduced quality of life in these patients. Currently, rehabilitative procedures are limited with physical therapy being the main treatment option. This study investigated the efficacy of repetitive navigated transcranial magnetic stimulation (rTMS) for treatment of motor deficits after supratentorial tumor resection. Methods This randomized, double-blind, sham-controlled trial (DRKS00010043) recruited patients with a postoperatively worsened upper extremity motor function immediately postoperatively. They were randomly assigned to receive rTMS (1Hz, 110% RMT, 15 minutes, 7 days) or sham stimulation to the motor cortex contralateral to the injury followed by physical therapy. Motor and neurological function as well as quality of life were assessed directly after the intervention, one month and three months postoperatively. Results Thirty patients were recruited for this study. There was no significant difference between both groups in the primary outcome, the Fugl Meyer score three months postoperatively [Group difference (95%-CI): 5.05 (-16.0; 26.1); p=0.631]. Patients in the rTMS group presented with better hand motor function one month postoperatively. Additionally, a subgroup of patients with motor eloquent ischemia showed lower NIHSS scores at all timepoints. Conclusions Low-frequency rTMS facilitated the recovery process in stimulated hand muscles, but with limited generalization to other functional deficits. Long-term motor deficits were not impacted by rTMS. Given the reduced life expectancy in these patients a shortened recovery duration of deficits can still be of high significance. Clinical Trial Registration https://drks.de/DRKS00010043.
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Affiliation(s)
- Melina Engelhardt
- Department of Neurosurgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- International Graduate Program Medical Neurosciences, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heike Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan Reuther
- Department for Physical Medicine, Charité -Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité – Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Cluster of Excellence Matters of Activity, Image Space Material, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tizian Rosenstock
- Department of Neurosurgery, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin Institute of Health (BIH) Biomedical Innovation Academy, Berlin Institute of Health (BIH) Charité Digital Clinician Scientist Program, Berlin, Germany
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Hunter H, Qin E, Wallingford A, Hyon A, Patel A. Neurorehabilitation for Adults with Brain and Spine Tumors. Semin Neurol 2024; 44:64-73. [PMID: 38049116 DOI: 10.1055/s-0043-1777407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Central nervous system (CNS) malignancies (i.e. brain and spine tumors) and their treatments can result in a multitude of neurologic deficits. Patients with CNS malignancies experience physical, cognitive, and psychosocial sequelae that can impact their mobility and quality of life. Neurorehabilitation can play a critical role in maintaining independence, preventing disability, and optimizing safety with activities of daily living. This review provides an overview of the neurorehabilitation approaches for patients with CNS malignancies, neurologic impairments frequently treated, and rehabilitation interventions in various health care settings. In addition, we will highlight rehabilitative outcomes between patients with nononcologic neurologic conditions compared to brain and spine tumors. Finally, we address medical challenges that may impact rehabilitation care in these medically complex cancer patients.
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Affiliation(s)
- Hanna Hunter
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Evelyn Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Allison Wallingford
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - April Hyon
- Department of Rehabilitation Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amar Patel
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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5
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Bartolo M, Intiso D, Zucchella C. Neurorehabilitation in brain tumours: evidences and suggestions for spreading of knowledge and research implementation. Curr Opin Oncol 2023; 35:543-549. [PMID: 37820089 DOI: 10.1097/cco.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW The last few decades have seen an increase in life expectancy in brain tumour patients; however, many patients report sensory-motor and cognitive disabilities due to the tumour itself, but also to the effect of anticancer treatments (surgery, radiotherapy, chemotherapy), supportive treatments, as well as individual patient factors. This review outlines the principles on which to base neurorehabilitation treatments, with the aim of stimulating an early rehabilitative management, in order to reduce disability and functional limitation and improve the quality of life of the persons affected by brain tumour. RECENT FINDINGS Although not definitive, evidences suggest that an early neurorehabilitative evaluation, performed with a multidisciplinary approach, may identify the different functional impairments that can affect people with brain tumour. Furthermore, identifying and classifying the person's level of functioning is useful for designing achievable recovery goals, through the implementation of tailored multidisciplinary rehabilitation programs. The involvement of different professional figures allows to treat all the components (physical, cognitive, psychological and participation) of the person, and to redesign one's life project, lastly improving the quality of life. SUMMARY Overall, the evidences suggest a critical need for the development of this clinical area by spreading the concept of rehabilitation among neuro-oncologists and producing high quality research.
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Affiliation(s)
- Michelangelo Bartolo
- Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Zingonia, Ciserano (BG)
| | - Domenico Intiso
- Unit of Neurorehabilitation and Rehabilitation Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG
| | - Chiara Zucchella
- Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy
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6
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McDougall E, Breen LJ, Nowak AK, Dhillon HM, Halkett GKB. Psychosocial interventions for personality and behavior changes in adults with a brain tumor: A scoping review. Neurooncol Pract 2023; 10:408-417. [PMID: 37720389 PMCID: PMC10502785 DOI: 10.1093/nop/npad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The objective of this scoping review was to describe the intervention characteristics and effectiveness of psychosocial interventions aimed at managing personality and behavior changes in people with brain tumors. A secondary objective was to explore if these interventions had an impact on outcomes for carers. Personality and behavior changes considered included aggression, apathy, paranoia, disinhibition, and emotional lability. Methods This review was conducted following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Searches were conducted in PsycINFO, CINAHL, Medline (Ovid), and Scopus. We synthesized studies published from 1996 to 2022 that evaluated interventions to manage brain tumor related personality and behavioral changes in adults. A data extraction tool were used based on the Joanna Briggs Institute template. Results are presented in a summary table and a narrative synthesis was conducted. Results Three thousand and five hundred and ninety-four records were screened. Title and abstract screening resulted in 29 potentially eligible studies. Full screening excluded 24 articles and 5 interventions met the inclusion criteria. The interventions were diverse in duration, delivery modality, setting, and participation (eg, the patient individually or patient and carer). The interventions reported improvements in the targeted personality and behavior change symptoms for patients with primary brain tumors. Four studies included a measure of personality and behavior change symptoms and two studies included a measure of outcomes for carers and reported improvements in carer knowledge and a reduction in carer distress. All studies sampled fewer than 100 participants. Studies had limited follow-up data and different tools were used to assess the presence and nature of personality and behavior changes. Conclusions There is a dearth of psychosocial interventions to support patients and their carers to manage brain tumor related personality and behavior changes.
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Affiliation(s)
- Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia
| | - Lauren J Breen
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia Perth, Perth, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia
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7
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Paterson C, Roberts C, Li J, Chapman M, Strickland K, Johnston N, Law E, Bacon R, Turner M, Mohanty I, Pranavan G, Toohey K. What are the experiences of supportive care in people affected by brain cancer and their informal caregivers: A qualitative systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01401-5. [PMID: 37256499 DOI: 10.1007/s11764-023-01401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. METHODS A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. RESULTS A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. CONCLUSION This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. IMPLICATIONS FOR CANCER SURVIVORS It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.
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Affiliation(s)
- C Paterson
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia.
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Canberra Health Services and ACT Health, Garran, Canberra, Australia.
- Robert Gordon University, Aberdeen, Scotland, UK.
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - J Li
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - M Chapman
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- Department of Palliative Care, Canberra Health Services, Garran, Canberra, Australia
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - K Strickland
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT, Auckland, New Zealand
| | - N Johnston
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - E Law
- Icon Cancer Centre, Canberra, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - I Mohanty
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - G Pranavan
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - K Toohey
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
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8
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Halkett GKB, Lobb EA, Phillips JL, McDougall E, Clarke J, Campbell R, Dhillon HM, McGeechan K, Hudson P, King A, Wheeler H, Kastelan M, Long A, Nowak AK. Carer preparedness improved by providing a supportive educational intervention for carers of patients with high-grade glioma: RCT results. J Neurooncol 2023; 161:501-513. [PMID: 36658381 PMCID: PMC9992082 DOI: 10.1007/s11060-023-04239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND High-grade glioma (HGG) is a rapidly progressing and debilitating disease. Family carers take on multiple responsibilities and experience high levels of distress. We aimed to deliver a nurse-led intervention (Care-IS) to carers to improve their preparedness to care and reduce distress. METHODS We conducted a randomised controlled trial (ACTRN:12612001147875). Carers of HGG patients were recruited during patients' combined chemoradiation treatment. The complex intervention comprised four components: (1) initial telephone assessment of carer unmet needs; (2) tailored hard-copy resource folder; (3) home visit; and, (4) monthly telephone support for up to 12 months. Primary outcomes included preparedness for caregiving and distress at 2, 4, 6 and 12 months. Intervention effects were estimated using linear mixed models which included a time by group interaction. Secondary outcomes included anxiety, depression, quality of life, carer competence and strain. RESULTS We randomised 188 carers (n = 98 intervention, n = 90 control). The intervention group reported significantly higher preparedness for caregiving at 4 months (model β = 2.85, 95% CI 0.76-4.93) and all follow-up timepoints including 12 months (model β = 4.35, 95% CI 2.08-6.62), compared to the control group. However, there was no difference between groups in carer distress or any secondary outcomes. CONCLUSIONS This intervention was effective in improving carer preparedness. However, carer distress was not reduced, potentially due to the debilitating/progressive nature of HGG and ongoing caring responsibilities. Future research must explore whether carer interventions can improve carer adjustment, self-efficacy and coping and how we support carers after bereavement. Additionally, research is needed to determine how to implement carer support into practice.
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Affiliation(s)
- Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, NSW, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Emma McDougall
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Jenny Clarke
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia.,Vrije University Brussels, Brussels, Belgium
| | - Anne King
- Cancer Network Western Australia, North Metropolitan Health Service, Perth, WA, Australia
| | - Helen Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia
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9
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Retzer A, Sivell S, Scott H, Nelson A, Bulbeck H, Seddon K, Grant R, Adams R, Watts C, Aiyegbusi OL, Kearns P, Cruz Rivera S, Dirven L, Baddeley E, Calvert M, Byrne A. Development of a core outcome set and identification of patient-reportable outcomes for primary brain tumour trials: protocol for the COBra study. BMJ Open 2022; 12:e057712. [PMID: 36180121 PMCID: PMC9528585 DOI: 10.1136/bmjopen-2021-057712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Primary brain tumours, specifically gliomas, are a rare disease group. The disease and treatment negatively impacts on patients and those close to them. The high rates of physical and cognitive morbidity differ from other cancers causing reduced health-related quality of life. Glioma trials using outcomes that allow holistic analysis of treatment benefits and risks enable informed care decisions. Currently, outcome assessment in glioma trials is inconsistent, hindering evidence synthesis. A core outcome set (COS) - an agreed minimum set of outcomes to be measured and reported - may address this. International initiatives focus on defining core outcomes assessments across brain tumour types. This protocol describes the development of a COS involving UK stakeholders for use in glioma trials, applicable across glioma types, with provision to identify subsets as required. Due to stakeholder interest in data reported from the patient perspective, outcomes from the COS that can be patient-reported will be identified. METHODS AND ANALYSIS Stage I: (1) trial registry review to identify outcomes collected in glioma trials and (2) systematic review of qualitative literature exploring glioma patient and key stakeholder research priorities. Stage II: semi-structured interviews with glioma patients and caregivers. Outcome lists will be generated from stages I and II. Stage III: study team will remove duplicate items from the outcome lists and ensure accessible terminology for inclusion in the Delphi survey. Stage IV: a two-round Delphi process whereby the outcomes will be rated by key stakeholders. Stage V: a consensus meeting where participants will finalise the COS. The study team will identify the COS outcomes that can be patient-reported. Further research is needed to match patient-reported outcomes to available measures. ETHICS AND DISSEMINATION Ethical approval was obtained (REF SMREC 21/59, Cardiff University School of Medicine Research Ethics Committee). Study findings will be disseminated widely through conferences and journal publication. The final COS will be adopted and promoted by patient and carer groups and its use by funders encouraged. PROSPERO REGISTRATION NUMBER CRD42021236979.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre, West Midlands, Birmingham, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Hannah Scott
- Cambridge Public Health, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Robin Grant
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard Adams
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Pamela Kearns
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
- Department of Neurology, Medical Centre Haaglanden, Den Haag, The Netherlands
| | - Elin Baddeley
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre, West Midlands, Birmingham, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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10
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Loizidou M, Sefcikova V, Ekert JO, Bone M, Samandouras G. Reforming support systems of newly diagnosed brain cancer patients: a systematic review. J Neurooncol 2022; 156:61-71. [PMID: 34826034 PMCID: PMC8714629 DOI: 10.1007/s11060-021-03895-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/05/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Despite the increasing incidence of currently incurable brain cancer, limited resources are placed in patients' support systems, with reactive utilisation late in the disease course, when physical and psychological symptoms have peaked. Based on patient-derived data and emphasis on service improvement, this review investigated the structure and efficacy of the support methods of newly diagnosed brain cancer patients in healthcare systems. METHODS This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Articles from PubMed, Embase, and CENTRAL databases were screened with six pre-established eligibility criteria, including assessment within 6 months from diagnosis of a primary malignant brain tumour. Risk of bias was evaluated using the Newcastle-Ottawa Scale and Critical Appraisal Skills Program (CASP) Qualitative Studies Checklist. RESULTS Of 5057 original articles, 14 were eligible for qualitative synthesis. Four studies were cross-sectional and ten were descriptive. Information given to patients was evaluated in seven studies, communication with patients in nine, and patient participation in treatment decisions in eight. Risk of bias was low in ten studies, moderate in two, and high in two. CONCLUSIONS Techniques promoting individualised care increased perceived support, despite poor patient-physician communication and complexity of the healthcare system. Extracted data across 14 included studies informed a set of guidelines and a four-step framework. These can help evaluate and reform healthcare services to better accommodate the supportive needs of this patient group.
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Affiliation(s)
- Maria Loizidou
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
| | - Viktoria Sefcikova
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
| | - Justyna O Ekert
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Matan Bone
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, UK
| | - George Samandouras
- UCL Queen Square Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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11
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Nordentoft S, Dieperink KB, Johansson SD, Jarden M, Piil K. Evaluation of a multimodal rehabilitative palliative care programme for patients with high-grade glioma and their family caregivers. Scand J Caring Sci 2021; 36:815-829. [PMID: 34296773 DOI: 10.1111/scs.13019] [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: 02/10/2021] [Accepted: 07/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients diagnosed with high-grade glioma and their family caregivers often experience intense disease and treatment trajectories. Fluctuations in patient's symptoms lead to enormous burdens for caregivers and the risk of developing symptoms of stress, anxiety, and depression. AIM The study aim is to explore patient and caregiver experiences and evaluate the relevance of and satisfaction with a multimodal rehabilitative palliative care programme for patients diagnosed with a high-grade glioma and their family caregivers. METHODS In a longitudinal multi-methods study, adult patients with high-grade glioma (n = 17) and their family caregivers (n = 16) completed a 4-day residential programme and a 2-day follow-up programme 3 months later. Participants completed questionnaires after each programme, scoring relevance and satisfaction on a 5-point Likert scale. Qualitative data were collected during four evaluation group interviews with patients and caregivers. RESULTS The mean overall satisfaction score was 4.80 (standard deviation [SD], 0.55) for the initial 4-day programme and 4.28 (SD, 0.83) for the follow-up programme. Three themes emerged in the evaluation group interviews: (1) meeting peers strengthens social well-being, (2) the value of information and focusing on individual needs, and (3) accepting life as an unpredictable passage. CONCLUSION Participants found completing the REHPA-HGG programme feasible and rated all sessions highly for relevance and satisfaction. Qualitative findings confirm the value of individualised information, acceptance, and peer interactions. IMPLICATION FOR PRACTICE A multimodal rehabilitative palliative care programme addressed unmet patient and caregiver needs. Peer-to-peer interventions for family caregivers may address individual support needs. Similar programmes may maximise benefit by avoiding planned behaviour changes and enhancing palliative approaches.
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Affiliation(s)
- Sara Nordentoft
- Research Unit, Center for Cancer and Organ Disease, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Center for Cancer and Organ Diseases, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Danish Center for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark.,Family Focused Healthcare Center (FaCe), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susan D Johansson
- Danish Center for Rehabilitation and Palliative Care, REHPA, Nyborg, Denmark
| | - Mary Jarden
- Department of Hematology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karin Piil
- Center for Cancer and Organ Diseases, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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12
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Milman L, Anderson E, Thatcher K, Amundson D, Johnson C, Jones M, Valles L, Willis D. Integrated Discourse Therapy After Glioblastoma: A Case Report of Face-To-Face and Tele-NeuroRehabilitation Treatment Delivery. Front Neurol 2020; 11:583452. [PMID: 33329328 PMCID: PMC7710897 DOI: 10.3389/fneur.2020.583452] [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: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Language and communication impairments are among the most frequently reported long-term behavioral consequences of brain tumor. Such deficits may persist long after a patient has been discharged from the hospital and can significantly impact return to work, resumption of prior social roles, and interpersonal relations, as well as full engagement in leisure activities. While considerable research has centered on identifying and describing communication impairments in brain tumor survivors, relatively little research has investigated language therapy for this population. Aims: This report (1) reviews the literature and describes the language and cognitive-communicative profile of a 35-year-old man 6 years post glioblastoma excision with subsequent chemo- and radiation therapies; (2) presents cognitive-communication outcome data for this individual following an integrated discourse therapy; and (3) assesses treatment feasibility in face-to-face (F2F) and tele-neurorehabilitation (TNR) contexts. Methods: A battery of tests and weekly conversation probes were administered to evaluate baseline performance and potential changes associated with F2F and TNR treatment delivery. Integrated Conversation Therapy (ICT) was administered across four alternating (F2F and TNR) treatment blocks over 2 months. ICT is a solution-focused discourse intervention that simultaneously targets word finding, sentence processing, and authentic patient-selected conversational interactions. Results: Although the participant presented with long term-language impairments that were clinically distinct from stroke-associated aphasia, statistically significant post-treatment gains (>2 SEM) were evident following F2F and TNR treatment delivery on standardized measures of apraxia, discourse production, verbal memory, and self-ratings of discourse production, communication, and living with aphasia. While objective measures of treatment effect size (probes of CIU discourse data) were consistent across F2F and TNR delivery models, results of a satisfaction survey indicated a slight but statistically significant participant preference for TNR treatment delivery. Conclusions: This study provides preliminary support for F2F and TNR delivery of ICT discourse intervention for glioblastoma survivors. It also highlights the need for more research specifically dedicated to language therapy for this population.
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Affiliation(s)
- Lisa Milman
- Language and Aphasia NeuroRehabilitation Lab, Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, United States
| | - Emma Anderson
- Language and Aphasia NeuroRehabilitation Lab, Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, United States
| | - Katelyn Thatcher
- Language and Aphasia NeuroRehabilitation Lab, Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, United States
| | - Deborah Amundson
- Language and Aphasia NeuroRehabilitation Lab, Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, United States
| | - Chance Johnson
- Language and Aphasia NeuroRehabilitation Lab, Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, United States
| | - Morgan Jones
- Language and Aphasia NeuroRehabilitation Lab, Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, United States
| | - Louie Valles
- Utah Education and Telehealth Network, Logan, UT, United States
| | - Dale Willis
- Utah Education and Telehealth Network, Logan, UT, United States
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13
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Zhao K, Yu C, Gan Z, Huang M, Wu T, Zhao N. Rehabilitation therapy for patients with glioma: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23087. [PMID: 33157978 PMCID: PMC7647558 DOI: 10.1097/md.0000000000023087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Glioma is the most common type of brain tumor because of the destructiveness of the disease itself and the side effects of treatment, patients often leave symptoms of neurological defects. At present, rehabilitation treatment is not popular in glioma patients. There is a lack of definite evidence to prove the benefits of rehabilitation therapy for glioma patients. The purpose of this meta-analysis is to determine whether rehabilitation therapy can significantly improve the prognosis of neurological function and improve the quality of life of patients with glioma. METHODS The articles about rehabilitation treatment of glioma in Cochrane, PubMed, and Embase, Web of Science, and Medline database from January 1990 to May 2020 were searched. Before rehabilitation as the control group, after rehabilitation as the experimental group. The Functional Independence Measure (FIM) was used as the outcome index, including total FIM, motor FIM, and cognitive FIM. Use STATA12.0 for meta-analysis. RESULTS A total of 8 articles were included in the study, with a total of 375 glioma patients. Meta-analysis of total FIM (SMD = 0.96, 95%CI = 0.66-1.26, P < .001), motor FIM (SMD = 0.75, 95%CI = 0.54-0.96, P < .001) and cognitive FIM (SMD = 0.35, 95%CI = 0.19-0.50, P < .001) indicated that the neurological function of rehabilitation was significantly improved in total, motor and consciousness. CONCLUSION The published studies show that rehabilitation therapy can improve the functional prognosis and quality of life of glioma patients. More attention should be paid to the therapeutic value of rehabilitation for glioma patients in the future. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020188740.
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Affiliation(s)
- Kai Zhao
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
| | - Chaojun Yu
- Neurosurgery Department, 903 Hospital, Jiangyou City, Sichuan Province
| | - Zhichao Gan
- Neurosurgery Department, Xinyang Central Hospital, Xinyang, Henan Province, China
| | - Minhao Huang
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
| | - Tingting Wu
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
| | - Ninghui Zhao
- Neurosurgery Department, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province
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14
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Ownsworth T, Chan RJ, Jones S, Robertson J, Pinkham MB. Use of telehealth platforms for delivering supportive care to adults with primary brain tumors and their family caregivers: A systematic review. Psychooncology 2020; 30:16-26. [PMID: 32915517 DOI: 10.1002/pon.5549] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Telehealth platforms have potential utility for providing remote access to supportive care to people with brain tumour. This systematic review aimed to evaluate the feasibility, acceptability and efficacy of delivering supportive care via telehealth platforms to adults with primary brain tumour and family caregivers. METHODS A systematic search of PsycINFO, MEDLINE, CINAHL, Embase, Scopus and Cochrane Library was conducted from 1980 to 1st June 2020 to identify eligible studies. Methodological quality was assessed by two independent reviewers. RESULTS Seventeen articles, reporting on 16 studies, evaluated telephone-based support (5 studies), videoconferencing (3 studies), web-based programs and resources (7 studies) or combined use of videoconferencing and web-based modules (1 study) to deliver supportive care remotely. Caregivers were involved in 31% of interventions. Mean rates of accrual (68%) and adherence (74%) were moderate, whereas acceptability or satisfaction for those completing the interventions was typically high (M satisfied or very satisfied = 81%). Adherence rates were generally higher and clinical gains were more evident for interventions involving real-time interaction as opposed to self-guided interventions. CONCLUSIONS Telehealth delivery of supportive care is feasible and acceptable to a high proportion of individuals with primary brain tumour and their caregivers. It is recommended that future research focuses on implementation outcomes, including factors influencing the uptake and sustainability of telehealth platforms in practice.
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Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Raymond J Chan
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital, Woolloongabba, Australia
| | - Stephanie Jones
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Julia Robertson
- School of Medicine, Griffith University, South Port, Australia
| | - Mark B Pinkham
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital, Woolloongabba, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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15
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Troschel FM, Brandt R, Wiewrodt R, Stummer W, Wiewrodt D. High-Intensity Physical Exercise in a Glioblastoma Patient under Multimodal Treatment. Med Sci Sports Exerc 2020; 51:2429-2433. [PMID: 31730561 DOI: 10.1249/mss.0000000000002067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Glioblastoma multiforme (GBM) carries a strongly unfavorable prognosis despite intensive multidisciplinary therapy. Physical exercise is rarely offered to patients for fear of adverse events such as falls, epileptic seizures, or bleeding, despite little supporting evidence. Here, we report a study of high-level and long-term exercise in a GBM patient. METHODS A 33-yr-old male, diagnosed with a large cystic GBM, was included in our institution's Personal Training Program after initial tumor resection and adjuvant radiochemotherapy. The program was designed to facilitate individual long-term high-intensity exercise. Supervised by a certified personal trainer, it consisted of at least four weekly training sessions and intermittent performance diagnostics. An activity tracker quantified training intensity. RESULTS In this setting, the patient exercised at high intensity without adverse events for 87 continuous weeks (21 months). He averaged 43.7 metabolic equivalent of task hours per week (MET·h·wk), well above the 75th percentile of healthy males the same age, while undergoing multiple surgeries, chemotherapy, and radiation therapy regimens. The patient completed two marathons averaging less than 5 min·km both times, despite tumor progression. Performance diagnostics indicated a gain of fitness even during continuous GBM treatment. Due to multiple intraventricular lesions and increasing intracranial pressure, training was stopped 6 wk before the patient passed away 2 yr after initial diagnosis. CONCLUSIONS This study demonstrates that high-intensity, long-term physical training regimens are feasible in GBM patients during full multidisciplinary therapy. In this patient, the exercise was pursued without adverse events and led to a gain of fitness despite tumor progression and intensive multiple therapies. We conclude that, in GBM patients, exercise regimens require further study instead of general discouragement.
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Affiliation(s)
- Fabian M Troschel
- Department of Medicine, Münster University Hospital, Münster, GERMANY
| | - Ralf Brandt
- Department of Neurosurgery, Münster University Hospital, Münster, GERMANY
| | - Rainer Wiewrodt
- Pulmonary Division, Department of Medicine A, Münster University Hospital, Münster, GERMANY
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital, Münster, GERMANY
| | - Dorothee Wiewrodt
- Department of Neurosurgery, Münster University Hospital, Münster, GERMANY
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16
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Maialetti A, Maschio M, Zarabla A, Polimadei C, Papa E, Villani V, Giannarelli D. Multimodal pathway for brain tumor-related epilepsy patients: Observational study. Acta Neurol Scand 2020; 141:450-462. [PMID: 32043558 DOI: 10.1111/ane.13228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/15/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Brain tumor-related epilepsy patients (BTRE) have a complex profile due to the simultaneous presence of two pathologies: brain tumor and epilepsy. That illness and their treatments could induce physical, cognitive, emotional disturbances, and possible social isolation, with detrimental effect on patients' quality of life (QoL). Aim of this observational pilot study is to evaluate whether a multimodal rehabilitation pathway (MRP) consisting of epileptological follow-up, neurocognitive training, emotional support, and social support could produce an improvement in perceived quality of life of 33 patients with BTRE. MATERIALS AND METHODS Basal (T0) and 6 month (T1) evaluation with epileptological, neuropsychological, psychological state (Symptom checklist-SCL-90), social (Social questionnaire schedule-SQS), and QoL assessment (QOLIE 31-P). MRP consisted in epileptological follow-up, supportive meeting groups, social assistance; patients with cognitive deficits could also obtain a 12-week neurocognitive training. RESULTS We observed at T1 significant improvements in mean seizure/month (P = .02), verbal memory (word list immediate recall, P = .01; word list delayed recall P = .003), social aspects with regard to assistencial network's efficacy (SQS network P = .001) and quality of social relations (SQS socialization P < .0001). QOLIE 31-P showed a significant improvement in cognitive scale (P = .04) and a significant decrease in cognitive related distress (P = .04). No psychopathological symptoms were detected. CONCLUSION After 6 months, MRP produced significant improvements in seizure control, cognitive performances, quality of social relations, patients' perception to be supported and patients' perceived quality of life related to cognitive efficacy. Future randomized trial with longer follow-up is needed to further evaluate the impact of this kind of pathway on patients' QoL.
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Affiliation(s)
- Andrea Maialetti
- Center for Tumor‐related epilepsy UOSD Neuroncology Regina Elena National Cancer Institute IRCCS IFO Rome Italy
| | - Marta Maschio
- Center for Tumor‐related epilepsy UOSD Neuroncology Regina Elena National Cancer Institute IRCCS IFO Rome Italy
| | - Alessia Zarabla
- Center for Tumor‐related epilepsy UOSD Neuroncology Regina Elena National Cancer Institute IRCCS IFO Rome Italy
| | - Camilla Polimadei
- Center for Tumor‐related epilepsy UOSD Neuroncology Regina Elena National Cancer Institute IRCCS IFO Rome Italy
| | - Elena Papa
- Hematology and Stem Cell Transplantation Unit Regina Elena National Cancer Institute IRCCS IFO Rome Italy
| | - Veronica Villani
- UOSD Neuroncology Regina Elena National Cancer Institute IRCCS IFO Rome Italy
| | - Diana Giannarelli
- Biostatistic Unit Regina Elena National Cancer Institute IRCCS IFO Rome Italy
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17
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Milbury K, Weathers SP, Durrani S, Li Y, Whisenant M, Li J, Lim B, Weinberg JS, Kesler SR, Cohen L, Bruera E. Online Couple-Based Meditation Intervention for Patients With Primary or Metastatic Brain Tumors and Their Partners: Results of a Pilot Randomized Controlled Trial. J Pain Symptom Manage 2020; 59:1260-1267. [PMID: 32061834 DOI: 10.1016/j.jpainsymman.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Although patients with primary and metastatic brain tumors and their partners are at risk of experiencing high symptom burden, they are often excluded from psychosocial intervention studies. Thus, we sought to examine the feasibility and preliminary efficacy of a couple-based meditation (CBM) program targeting symptom and well-being outcomes. METHODS Couples completed baseline measures assessing symptom and well-being outcomes and were randomized to the CBM or a usual care control group. Couples in the CBM groups attended four weekly (60 minutes each) therapist-led sessions that were delivered via FaceTime (Apple Inc, Cupertino, CA). The CBM program focused on cultivating mindfulness, compassion, gratitude and purpose, and integrated emotional disclosure exercises. Both groups were reassessed six and 12 weeks after baseline. RESULTS We approached 60 eligible dyads, of which 37 (62%) consented, 35 (95%) were randomized, and 22 (63%) completed all assessments. Couples in the CBM group attended a mean of 3.33 sessions (SD 1.09). For patients, significant group differences in favor of the CBM group were found for cognitive (d = 1.05) and general disease symptoms (d = 0.93), and relationship well-being (d = 0.68) and compassion (d = 0.96). No significant group differences were revealed for partners. CONCLUSION It seems to be feasible, acceptable, and possibly efficacious to deliver a dyadic intervention via FaceTime to brain tumor couples. Although both patients and partners in the CBM group rated the intervention as beneficial, significant group differences with medium-to-large effect sizes were only found for patients.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sania Durrani
- Department of Behavioral Science, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Meagan Whisenant
- Department of Symptom Research, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Shelli R Kesler
- Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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18
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Spychka RA, Purdy GM, Easaw JC, Littleton R, Murtha AD, Driga A, Culos-Reed SN, McNeely ML. Feasibility of performance-based functional assessment in brain tumour survivors. Eur J Cancer Care (Engl) 2020; 29:e13238. [PMID: 32369244 DOI: 10.1111/ecc.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/04/2020] [Accepted: 04/10/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rehabilitation and exercise interventions are beneficial for the physical and psychological health of cancer survivors. Current clinic-based performance status measures do not accurately capture the survivor's functioning, or rehabilitation and exercise needs. Our primary objective was to explore the feasibility of performing a performance-based functional assessment with brain tumour survivors as a means to inform needs for rehabilitation and exercise. METHODS A feasibility study was conducted with survivors of brain and other neurological cancers attending new patient or follow-up clinics. Survivors were assessed using the Short Physical Performance Battery (SPPB), grip strength and Rosow-Breslau Physical Activity Self-Assessment (RSB). RESULTS We approached 40 survivors with brain tumours, and 30 agreed to participate in the study. The SPPB was inversely correlated with Eastern Cooperative Oncology Group (ECOG) scores (r = -.73; p < .01), but scores on the SPPB for individuals classified as ECOG 1 ranged from 5 to 12 out of 12, indicating a large variability in functional scores within this ECOG grade. CONCLUSION Implementation of objective functional testing is feasible in the neuro-oncology outpatient clinic. The SPPB appears to best inform the functional status of survivors with brain tumours, facilitating more individualised exercise and rehabilitation referrals.
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Affiliation(s)
- Ryan A Spychka
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Graeme M Purdy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jacob C Easaw
- Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Albert D Murtha
- Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Amy Driga
- Rehabilitation Medicine, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Rehabilitation Medicine, Cross Cancer Institute, Edmonton, AB, Canada
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19
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Abstract
PURPOSE OF REVIEW The concept of palliative care is becoming increasingly important in the management of glioma patients. However, the right time for implementation, as well as the individual degree of integration of palliative care aspects, are still a matter of debate. This review updates recent evidence of palliative care in glioma and raises questions for future developments. RECENT FINDINGS According to the disease-specific aspects of palliative care in glioma management, there is an increasing need for a specialized 'neurooncological' palliative care approach.The implementation of palliative care for glioma patients and caregivers avoids unnecessary hospitalization and reduces health-related costs. Moreover, palliative care may be offered in different settings (inpatient/outpatient) according to local health structures, but definitely improves the QOL of glioma patients and their caregivers. SUMMARY There are considerable differences between countries with respect to palliative care in glioma. Major aspects of good-quality care throughout the countries are optimized symptom control, support for patients and proxies by an interdisciplinary team and to provide realistic information to patients and caregivers. The availability of neurooncological palliative teams and multidisciplinary support programs increases well being of glioma patients and caregivers as well as releases pressure on healthcare systems.
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Feasibility, Safety and Effects of a One-Week, Ski-Based Exercise Intervention in Brain Tumor Patients and Their Relatives: A Pilot Study. J Clin Med 2020; 9:jcm9041006. [PMID: 32252441 PMCID: PMC7231125 DOI: 10.3390/jcm9041006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
A brain tumor diagnosis poses a significant psychological burden and it severely impacts quality of life (QOL), both in patients and relatives. However, comprehensive strategies addressing QOL in this setting remain rare. Here, we aim to share our findings of a one-week ski exercise intervention, with emphasis on feasibility, safety, QOL, and physical exercise. The intervention consisted of week-long daily ski sessions with professional ski guides as well as dedicated physicians present. The participants were handed questionnaires, including distress and QOL items before, during, and after the intervention. Using fitness watches, exercise intensity was also tracked at these timepoints. During the intervention, patients were checked for adverse events daily. Fifteen participants, nine patients after multidisciplinary treatment, and six relatives were included in the study. Additionally, 13 children participated in the exercise, but not in the study. All of the participants completed the entire program. No severe adverse events were documented during daily checks. There was a strong increase in quantified activity and QOL with a corresponding decrease in distress during the intervention, and, partly, afterwards. This prospective brain tumor rehabilitation study demonstrates the feasibility and safety of challenging ski exercise in brain tumor patients. The findings also underline the exercise-mediated QOL benefits, emphasizing the need for more comprehensive brain tumor rehabilitation programs.
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Golla H, Nettekoven C, Bausewein C, Tonn JC, Thon N, Feddersen B, Schnell O, Böhlke C, Becker G, Rolke R, Clusmann H, Herrlinger U, Radbruch L, Vatter H, Güresir E, Stock S, Müller D, Civello D, Papachristou I, Hellmich M, Hamacher S, Voltz R, Goldbrunner R. Effect of early palliative care for patients with glioblastoma (EPCOG): a randomised phase III clinical trial protocol. BMJ Open 2020; 10:e034378. [PMID: 31915175 PMCID: PMC6955518 DOI: 10.1136/bmjopen-2019-034378] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION: Randomised controlled trials (RCTs) have shown a positive effect of early integration of palliative care (EIPC) in various advanced cancer entities regarding patients' quality of life (QoL), survival, mood, caregiver burden and reduction of aggressiveness of treatment near the end of life. However, RCTs investigating the positive effect of EIPC for patients suffering from glioblastoma multiforme (GBM) are lacking. After modelling work identifying the specific needs of GBM patients and their caregivers, the aim of this study is to investigate the impact of EIPC in this particular patient group. METHODS AND ANALYSIS: The recruitment period of this multicenter RCT started in May 2019. GBM patients (n=214) and their caregivers will be randomly assigned to either the intervention group (receiving proactive EIPC on a monthly basis) or the control group (receiving treatment according to international standards and additional, regular assessment of QoL ('optimised' standard care)).The primary outcome is QoL assessed by subscales of the Functional Assessment of Cancer Therapy for brain tumour (FACT-Br) from baseline to 6 months of treatment. Secondary outcomes are changes in QoL after 12 (end of intervention), 18 and 24 months (end of follow-up), the full FACT-Br scale, patients' palliative care needs, depression/anxiety, cognitive impairment, caregiver burden, healthcare use, cost-effectiveness and overall survival. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the Declaration of Helsinki and has been approved by the local ethics committees of the University Clinics of Cologne, Aachen, Bonn, Freiburg and Munich (LMU). Results of the trial will be submitted for publication in a peer-reviewed, open access journal and disseminated through presentations at conferences. TRIAL REGISTRATION NUMBER: German Register for Clinical Studies (DRKS) (DRKS00016066); Pre-results.
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Affiliation(s)
- Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Charlotte Nettekoven
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Department of General Neurosurgery, Faculty of Medicine and University Hospital, Center for Neurosurgery, University of Cologne, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Munich (LMU), Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Munich (LMU), Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Munich (LMU), Munich, Germany
| | - Berend Feddersen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Munich (LMU), Munich, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Freiburg, Freiburg, Germany
| | - Christopher Böhlke
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Freiburg, Freiburg, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, RWTH Aachen University, Aachen, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
| | - Hans Clusmann
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Department of Neurosurgery, Faculty of Medicine and University Hospital, RWTH Aachen University, Aachen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, Faculty of Medicine and University Hospital, University of Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Bonn, Bonn, Germany
| | - Hartmut Vatter
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Bonn, Bonn, Germany
| | - Erdem Güresir
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Bonn, Bonn, Germany
| | - Stephanie Stock
- Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Dirk Müller
- Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Daniele Civello
- Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Irini Papachristou
- Faculty of Medicine and University Hospital, Center for Clinical Studies (ZKS), University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Clinical Studies (ZKS), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Faculty of Medicine and University Hospital, Center for Neurosurgery, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
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Fahrenholtz ML, Hansen A, Søgaard K, Andersen LN. Finding 'the inner drive' for a rehabilitation process: a small-scale qualitative investigation among male patients with primary glioma. BMJ Open 2019; 9:e031665. [PMID: 31818840 PMCID: PMC6924832 DOI: 10.1136/bmjopen-2019-031665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Brain tumours are relatively rare but hold a significant place in cancer rehabilitation due to their pronounced disabling capacity to promote physical, cognitive and psychosocial sequelae. This small-scale qualitative study used coping and motivational theories to gain understanding and knowledge of patients' experience of being diagnosed with a severe disease and of their view of a rehabilitation process. DESIGN Qualitative interview study. SETTING Odense University Hospital, Denmark. INFORMANTS Five patients (men, aged 30-79 years) with primary glioma who had participated in a rehabilitation intervention. METHODS Semi-structured interviews were conducted. The phenomenological interpretive analysis was used to analyse the interviews. RESULTS The analysis revealed three main themes: (1) coping with a new life situation, (2) motivating and maintaining elements and (3) experience of the benefit of the rehabilitation programme. CONCLUSION The study concluded that interviewed informants use problem-solving coping strategies, which make them more active in their health behaviour. However, passive and emotion-focused strategies related to confronting diagnosis may be used in some cases. The motivational aspect is multifaceted. Personal and interpersonal elements alongside a competitive setting are crucial to self-efficacy and benefit. The intervention's impact on health-related quality of life also has the potential to increase patients' resources to manage their situation. TRIAL REGISTRATION NUMBER NCT02221986.
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Affiliation(s)
| | - Anders Hansen
- Clinical Research, University Hospital of Odense, Odense, Denmark
- Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Clinical Research, University Hospital of Odense, Odense, Denmark
- Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lotte Nygaard Andersen
- Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Subjective cognitive functioning and associations with psychological distress in adult brain tumour survivors. J Cancer Surviv 2019; 13:653-662. [PMID: 31313128 DOI: 10.1007/s11764-019-00784-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The impact of brain tumour on subjective cognitive function (SCF) has received little attention despite the implications of these perceptions for quality of life. SCF consists of two related yet distinct components, perceived cognitive impairment (PCI) and perceived cognitive abilities (PCA). This study compared the SCF of adult brain tumour survivors and healthy controls and examined demographic, illness-related, and psychological factors associated with SCF. METHOD Sixty-five adult survivors with primary brain tumour (age, 22-75 years), and 65 age- and sex-matched controls were recruited. Participants with brain tumour completed the Brief Test of Adult Cognition by Telephone, Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), ratings of physical symptoms, Depression Scale of the Depression Anxiety Stress Scales-21 (DASS-Depression), and Generalized Anxiety Disorder-7 (GAD-7) scale. Controls completed the FACT-Cog, DASS-Depression, and GAD-7. RESULTS Adult brain tumour survivors reported significantly greater PCI and lower PCA than controls, after accounting for anxiety. Higher PCI was significantly related to fatigue, pain, treatment-related side-effects, anxiety, and depression. Lower PCA was significantly associated with fatigue, pain, poorer objective cognitive function, lower education, anxiety, and depression. Anxiety uniquely accounted for 9-14% of variance in SCF. CONCLUSIONS Adult brain tumour survivors were found to experience poorer SCF than healthy controls after accounting for anxiety. SCF was related to multiple factors after brain tumour; however, an independent association with anxiety was identified. IMPLICATIONS FOR CANCER SURVIVORS These findings highlight the potential value of psychological interventions targeting anxiety and cognitive effects to improve quality of survivorship after brain tumour.
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Ownsworth T, Chambers S, Aitken JF, Foote M, Pinkham MB, Gordon LG, Lock G, Hanley B, Gardner T, Jones S, Robertson J, Shum D, Conlon E. Evaluation of a telehealth psychological support intervention for people with primary brain tumour and their family members: Study protocol for a randomised controlled trial. Eur J Cancer Care (Engl) 2019; 28:e13132. [DOI: 10.1111/ecc.13132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/30/2019] [Accepted: 06/22/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Suzanne Chambers
- University of Technology Sydney Sydney New South Wales Australia
- Menzies Health Institute Queensland Griffith University Southport Queensland Australia
- Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group Sydney New South Wales Australia
- Exercise Medicine Research Institute Edith Cowan University Perth Western Australia Australia
- Institute for Resilient Regions University of Southern Queensland Toowoomba Queensland Australia
| | - Joanne F. Aitken
- Menzies Health Institute Queensland Griffith University Southport Queensland Australia
- Institute for Resilient Regions University of Southern Queensland Toowoomba Queensland Australia
- Cancer Council Queensland Brisbane Queensland Australia
- School of Public Health University of Queensland Brisbane Queensland Australia
- School of Research–Public Health Queensland University of Technology Brisbane Queensland Australia
| | - Matthew Foote
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Mark B. Pinkham
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Louisa G. Gordon
- School of Public Health University of Queensland Brisbane Queensland Australia
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
- School of Nursing Queensland University of Technology Brisbane Queensland Australia
| | - Gemma Lock
- Cancer Council Queensland Brisbane Queensland Australia
| | - Brigid Hanley
- Cancer Council Queensland Brisbane Queensland Australia
| | | | - Stephanie Jones
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Julia Robertson
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - David Shum
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- Department of Rehabilitation Sciences Hong Kong Polytechnic University Hong Kong China
| | - Elizabeth Conlon
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
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Boele FW, Rooney AG, Bulbeck H, Sherwood P. Interventions to help support caregivers of people with a brain or spinal cord tumour. Cochrane Database Syst Rev 2019; 7:CD012582. [PMID: 31264707 PMCID: PMC6604115 DOI: 10.1002/14651858.cd012582.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The diagnosis and treatment of a brain or spinal cord tumour can have a huge impact on the lives of patients and their families with family caregiving often resulting in considerable burden and distress. Meeting the support needs of family caregivers is critical to maintain their emotional and physical health. Although support for caregivers is becoming more widely available, large-scale implementation is hindered by a lack of high-quality evidence for its effectiveness in the neuro-oncology caregiver population. OBJECTIVES To assess the effectiveness of supportive interventions at improving the well-being of caregivers of people with a brain or spinal cord tumour. To assess the effects of supportive interventions for caregivers in improving the physical and emotional well-being of people with a brain or spinal cord tumour and to evaluate the health economic benefits of supportive interventions for caregivers. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), MEDLINE via Ovid, and Embase via Ovid. We also handsearched relevant published conference abstracts (previous five years), publications in the two main journals in the field (previous year), searched for ongoing trials via ClinicalTrials.gov, and contacted research groups in the field. The initial search was in March 2017 with an update in August 2018 (handsearches completed in January 2019). SELECTION CRITERIA We included all randomised controlled trials (RCTs) where caregivers of neuro-oncology patients constituted more than 20% of the sample and which evaluated changes in caregiver well-being following any supportive intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and carried out risk of bias assessments. We aimed to extract data on the outcomes of psychological distress, burden, mastery, quality of patient-caregiver relationship, quality of life, and physical functioning. MAIN RESULTS In total, the search identified 2102 records, of which we reviewed 144 in full text. We included eight studies. Four interventions focused on patient-caregiver dyads and four were aimed specifically at the caregiver. Heterogeneity of populations and methodologies precluded meta-analysis. Risk of bias varied, and all studies included only small numbers of neuro-oncology caregivers (13 to 56 participants). There was some evidence for positive effects of caregiver support on psychological distress, mastery, and quality of life (low to very low certainty of evidence). No studies reported significant effects on caregiver burden or quality of patient-caregiver relationship (low to very low certainty of evidence). None of the studies assessed caregiver physical functioning. For secondary outcomes (patient emotional or physical well-being; health economic effects), we found very little to no evidence for the effectiveness of caregiver support. We identified five ongoing trials. AUTHORS' CONCLUSIONS The eight small-scale studies included employed different methodologies across different populations, with low certainty of evidence overall. It is not currently possible to draw reliable conclusions regarding the effectiveness of supportive interventions aimed at improving neuro-oncology caregiver well-being. More high-quality research is needed on support for family caregivers of people diagnosed, and living, with a brain or spinal cord tumour.
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Affiliation(s)
- Florien W Boele
- University of Leeds and Leeds Cancer CentreLeeds Institute of Health Sciences and Leeds Institute of Cancer and PathologyPOG, Level 3, Bexley WingSt James's Institute of OncologyLeedsUKLS9 7TF
| | - Alasdair G Rooney
- Edinburgh Centre for Neuro‐Oncology (ECNO)Department of Psychological MedicineWestern General HospitalCrewe Road SouthEdinburghScotlandUKEH4 2XU
| | - Helen Bulbeck
- brainstrustDirector of Services4 Yvery CourtCastle RoadCowesIsle of WightUKPO31 7QG
| | - Paula Sherwood
- University of PittsburghDepartment of Acute and Tertiary Care336 Victoria Building3500 Victoria StreetPittsburghMAUSA15261
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Cognitive rehabilitation for executive dysfunction in brain tumor patients: a pilot randomized controlled trial. J Neurooncol 2019; 142:565-575. [DOI: 10.1007/s11060-019-03130-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/21/2019] [Indexed: 11/25/2022]
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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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Pan-Weisz TM, Kryza-Lacombe M, Burkeen J, Hattangadi-Gluth J, Malcarne VL, McDonald CR. Patient-reported health-related quality of life outcomes in supportive-care interventions for adults with brain tumors: A systematic review. Psychooncology 2018; 28:11-21. [DOI: 10.1002/pon.4906] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/26/2018] [Accepted: 08/30/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Tonya M. Pan-Weisz
- San Diego State University/University of California; San Diego Joint Doctoral Program in Clinical Psychology; San Diego California
- University of California, San Diego Moores Cancer Center; San Diego California
| | - Maria Kryza-Lacombe
- San Diego State University/University of California; San Diego Joint Doctoral Program in Clinical Psychology; San Diego California
| | - Jeffrey Burkeen
- University of California, San Diego Moores Cancer Center; San Diego California
- Department of Radiation Medicine and Applied Sciences; University of California, San Diego; San Diego California
| | - Jona Hattangadi-Gluth
- University of California, San Diego Moores Cancer Center; San Diego California
- Department of Radiation Medicine and Applied Sciences; University of California, San Diego; San Diego California
| | - Vanessa L. Malcarne
- San Diego State University/University of California; San Diego Joint Doctoral Program in Clinical Psychology; San Diego California
- University of California, San Diego Moores Cancer Center; San Diego California
- Department of Psychology; San Diego State University; San Diego California
| | - Carrie R. McDonald
- San Diego State University/University of California; San Diego Joint Doctoral Program in Clinical Psychology; San Diego California
- University of California, San Diego Moores Cancer Center; San Diego California
- Department of Radiation Medicine and Applied Sciences; University of California, San Diego; San Diego California
- Department of Psychiatry; University of California, San Diego; San Diego California
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Fu JB, Morishita S, Yadav R. Changing Paradigms in the Rehabilitation of Inpatients with Brain Tumors. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:115-120. [PMID: 29868247 PMCID: PMC5983897 DOI: 10.1007/s40141-018-0182-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neurologic tumors account for over 50% of American acute inpatient rehabilitation facility cancer admissions. WHO Grade IV astrocytoma (also known as glioblastoma multiforme, high grade glioma or GBM) is the most common primary brain tumor in adults and is invariably fatal. The majority of primary brain tumor patients experience neurologic deficits. However, under-referral from oncology to rehabilitation has been reported. This brief narrative review article covers functional, medical and regulatory considerations when rehabilitating brain tumor inpatients.
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Affiliation(s)
- Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Rajesh Yadav
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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Jansson MRN, von Heymann-Horan A, Rasmussen BK, Albieri V, Frederiksen K, Suppli N, Dalton SO, Johansen C, Bidstrup PE. Risk for use of antidepressants, anxiolytics, and hypnotics in partners of glioma patients-A nationwide study covering 19 years of prescriptions. Psychooncology 2018; 27:1930-1936. [PMID: 29683227 DOI: 10.1002/pon.4744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Suffering from malignant brain tumor is a stressful condition, for patients and their partners. In a retrospective cohort study using nationwide registries, we examined partners' risk for first use of antidepressants, anxiolytics, or hypnotics. METHODS We followed all 4373 partners of adults with glioma, diagnosed in 1998 to 2013 in Denmark and a cohort of 43 808 partners of glioma-free persons matched 1:10. In Cox proportional hazard models, we estimated hazard ratios (HRs) for a first prescription of psychotropic medications (antidepressants, anxiolytics, or hypnotics) according to the partner's glioma status. Among partners of glioma patients, we further estimated HRs for a first prescription of psychotropic medication according to disease characteristics, sociodemographic factors, and bereavement. RESULTS Two years after diagnosis, 29% of female and 21% of male partners of glioma patients had had a first prescription of psychotropic medication compared with 10% in female and 8% in male partners of glioma-free persons. Partners of glioma patients had a significantly increased, 4-fold higher risk for a first prescription of psychotropic medications in the first year after diagnosis than partners of glioma-free persons (HR 4.10, 95% CI, 3.80:4.43). Among partners of glioma patients, the risk was significantly reduced in bereaved compared with non-bereaved partners. CONCLUSIONS We have documented, for the first time, that the psychological impact of a diagnosis of glioma is such a severe stress exposure that it increases the risk for having medication prescribed to treat symptoms of anxiety, sleep problems, and depression.
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Affiliation(s)
| | | | - Birthe K Rasmussen
- Department of Neurology, Nordsjaellands Hospital, University of Copenhagen, Denmark.,Danish Neuro-Oncology, Denmark
| | - Vanna Albieri
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Nis Suppli
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, University Hospital Rigshospitalet, Copenhagen, Denmark
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Abstract
Patients with brain tumor exhibit wide-ranging prognoses and functional implications of their disease and treatments. In general, the supportive care needs of patients with brain tumor, including disabling effects, have been recognized to be high. This review (1) briefly summarizes brain tumor types, treatments, and prognostic information for the rehabilitation clinician; (2) reviews evidence for rehabilitation, including acute inpatient rehabilitation and cognitive rehabilitation, and the approaches to selected common symptom and medical management issues; and (3) examines emerging data about survivorship, such as employment, community integration, and fitness.
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Affiliation(s)
- Mary M Vargo
- Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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Katakami N, Uchino J, Yokoyama T, Naito T, Kondo M, Yamada K, Kitajima H, Yoshimori K, Sato K, Saito H, Aoe K, Tsuji T, Takiguchi Y, Takayama K, Komura N, Takiguchi T, Eguchi K. Anamorelin (ONO-7643) for the treatment of patients with non-small cell lung cancer and cachexia: Results from a randomized, double-blind, placebo-controlled, multicenter study of Japanese patients (ONO-7643-04). Cancer 2018; 124:606-616. [PMID: 29205286 PMCID: PMC5814824 DOI: 10.1002/cncr.31128] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cachexia, described as weight loss (mainly in lean body mass [LBM]) and anorexia, is common in patients with advanced cancer. This study examined the efficacy and safety of anamorelin (ONO-7643), a novel selective ghrelin receptor agonist, in Japanese cancer patients with cachexia. METHODS This double-blind clinical trial (ONO-7643-04) enrolled 174 patients with unresectable stage III/IV non-small cell lung cancer (NSCLC) and cachexia in Japan. Patients were randomized to daily oral anamorelin (100 mg) or a placebo for 12 weeks. The primary endpoint was the change from the baseline LBM (measured with dual-energy x-ray absorptiometry) over 12 weeks. The secondary endpoints were changes in appetite, body weight, quality of life, handgrip strength (HGS), and 6-minute walk test (6MWT) results. RESULTS The least squares mean change (plus or minus the standard error) in LBM from the baseline over 12 weeks was 1.38 ± 0.18 and -0.17 ± 0.17 kg in the anamorelin and placebo groups, respectively (P < .0001). Changes from the baseline in LBM, body weight, and anorexia symptoms showed significant differences between the 2 treatment groups at all time points. Anamorelin increased prealbumin at weeks 3 and 9. No changes in HGS or 6MWT were detected between the groups. Twelve weeks' treatment with anamorelin was safe and well tolerated in NSCLC patients. CONCLUSIONS Anamorelin significantly increased LBM and improved anorexia symptoms and the nutritional state, but not motor function, in Japanese patients with advanced NSCLC. Because no effective treatment for cancer cachexia is currently available, anamorelin can be a beneficial treatment option. Cancer 2018;124:606-16. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Affiliation(s)
- Nobuyuki Katakami
- Division of Integrated Oncology, Institute of Biomedical Research and InnovationKobeJapan
| | - Junji Uchino
- Department of Pulmonary MedicineKyoto Prefectural University of MedicineKyotoJapan
- Department of Respiratory MedicineFukuoka University School of MedicineFukuokaJapan
| | - Takuma Yokoyama
- Department of Respiratory MedicineKyorin University HospitalMitakaJapan
| | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Masashi Kondo
- Department of Respiratory Medicine Graduate School of MedicineNagoya UniversityNagoyaJapan
- Department of Respiratory MedicineFujita Health UniversityToyoakeJapan
| | - Kouzo Yamada
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Hiromoto Kitajima
- Department of Respiratory MedicineNational Hospital Organization Shikoku Cancer CenterMatsuyamaJapan
| | - Kozo Yoshimori
- Department of Clinical Oncology, Japan Anti‐Tuberculosis AssociationFukujuji HospitalKiyoseJapan
| | - Kazuhiro Sato
- Department of Respiratory MedicineNagaoka Red Cross HospitalNagaokaJapan
| | - Hiroshi Saito
- Department of Respiratory MedicineAichi Cancer Center Aichi HopitalAichiJapan
| | - Keisuke Aoe
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterUbeJapan
| | - Tetsuya Tsuji
- Department of Rehabilitation MedicineKeio University School of MedicineTokyoJapan
| | - Yuichi Takiguchi
- Department of Medical OncologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Koichi Takayama
- Department of Pulmonary MedicineKyoto Prefectural University of MedicineKyotoJapan
| | | | | | - Kenji Eguchi
- Health Science on Supportive Medicine for Intractable DiseasesTeikyo University School of MedicineTokyoJapan
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Reblin M, Small B, Jim H, Weimer J, Sherwood P. Mediating burden and stress over time: Caregivers of patients with primary brain tumor. Psychooncology 2017; 27:607-612. [PMID: 28801927 PMCID: PMC10111220 DOI: 10.1002/pon.4527] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/20/2017] [Accepted: 08/04/2017] [Indexed: 11/06/2022]
Abstract
There is a growing literature on the effects of cancer caregiving on the well-being of informal family caregivers. However, there has been little longitudinal research on caregivers of patients with the complex, rapidly-changing disease of primary malignant brain tumor. OBJECTIVE Our objective was to model longitudinal relationships between caregiver burden, social support, and distress within caregivers of patients with primary brain tumor. METHODS Caregiver participants were recruited from a neuro-oncology clinic. Caregiver questionnaire data, including sociodemographics, social support, depression, anxiety, and caregiving burden, were collected at 4 time points (diagnosis, +4, +8, and +12 mo). Using the stress process model as a guide, we hypothesized that early burden would predict later depression and anxiety, and this would be mediated by social support. RESULTS Using data from 147 participants, we found support for the stress process model in caregivers of patients with primary brain tumor. Greater burden at diagnosis was associated with lower social support at 4 months, and lower social support was related to higher depression and anxiety at 8 months, as well as to changes in anxiety between 8 and 12 months. CONCLUSION We found evidence of the stress process model in caregivers of primary brain tumor patients unfolding over the course of a year after diagnosis. Our findings emphasize the potential importance of early programs for caregivers to ensure low initial levels of burden, which may have a positive effect on social support, depression, and anxiety.
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Pace A, Dirven L, Koekkoek JAF, Golla H, Fleming J, Rudà R, Marosi C, Rhun EL, Grant R, Oliver K, Oberg I, Bulbeck HJ, Rooney AG, Henriksson R, Pasman HRW, Oberndorfer S, Weller M, Taphoorn MJB. European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma. Lancet Oncol 2017; 18:e330-e340. [DOI: 10.1016/s1470-2045(17)30345-5] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022]
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Boele FW, Grant R, Sherwood P. Challenges and support for family caregivers of glioma patients. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjnn.2017.13.1.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Robin Grant
- Consultant neurologist, Edinburgh Centre for Neuro-Oncology
| | - Paula Sherwood
- Professor, University of Pittsburgh (Acute and Tertiary Care, School of Nursing)
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Milbury K, Mallaiah S, Mahajan A, Armstrong T, Weathers SP, Moss KE, Goktepe N, Spelman A, Cohen L. Yoga Program for High-Grade Glioma Patients Undergoing Radiotherapy and Their Family Caregivers. Integr Cancer Ther 2017; 17:332-336. [PMID: 28150503 PMCID: PMC6041937 DOI: 10.1177/1534735417689882] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Despite their high symptom burden and poor prognosis, evidence-based supportive care interventions for adults with high-grade glioma (HGG) and their caregivers are lacking. Thus, we aimed to establish feasibility of a patient-caregiver dyadic yoga program (DYP) for newly diagnosed HGG patients and their family caregivers targeting quality-of-life (QOL) outcomes. Method: In this single-arm pilot trial, dyads participated in a 12-session DYP program across the course of patients’ radiotherapy. The intervention focused on breathing exercises, gentle movements, and guided meditations. We tracked feasibility data and assessed levels of cancer-related symptoms (MD Anderson Symptom Inventory [MDASI]), depressive symptoms (Centers for Epidemiological Studies-Depression scale), fatigue (Brief Fatigue Inventory), sleep disturbances (Pittsburgh Sleep Quality Index [PSQI]), and overall mental and physical QOL (36-item Short-Form Survey [SF-36]) at baseline and post-DYP, which was at the end of radiotherapy. Results: We approached 6 dyads of which 5 dyads (86%) consented and completed all 12 sessions and pre/post assessments. All patients (mean age: 52 years, 80% female, 80% grade IV) and caregivers (mean age: 58 years, 80% female, 60% spouses) perceived benefit from the program. Paired t tests revealed a marginally significant, yet clinically meaningful, decrease in patient’s cancer symptoms (t = 2.32, P = .08; MDASI mean; pre = 1.75, post = 1.04). There were clinically significant reductions in patient sleep disturbances (PSQI mean: pre = 10.75, post = 8.00) and improvements in patient and caregiver mental QOL (MCS of SF-36 mean: pre = 42.35, post = 52.34, and pre = 45.14, post = 51.43, respectively). Conclusions: This novel supportive care program appears to be safe, feasible, acceptable, and subjectively useful for HGG patients and their caregivers. There was also preliminary evidence regarding QOL treatment gains for both patients and caregivers.
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Affiliation(s)
- Kathrin Milbury
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Smitha Mallaiah
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Mahajan
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Terri Armstrong
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kathryn E Moss
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nazli Goktepe
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Spelman
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Renovanz M, Hickmann AK, Coburger J, Kohlmann K, Janko M, Reuter AK, Keric N, Nadji-Ohl M, König J, Singer S, Giese A, Hechtner M. Assessing psychological and supportive care needs in glioma patients - feasibility study on the use of the Supportive Care Needs Survey Short Form (SCNS-SF34-G) and the Supportive Care Needs Survey Screening Tool (SCNS-ST9) in clinical practice. Eur J Cancer Care (Engl) 2016; 27. [DOI: 10.1111/ecc.12598] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Affiliation(s)
- M. Renovanz
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - A.-K. Hickmann
- Center for Endoscopic and Minimally Invasive Neurosurgery; Hirslanden; Zürich Switzerland
- Department of Neurosurgery Klinikum Stuttgart; Katharinenhospital; Stuttgart Germany
| | - J. Coburger
- Department of Neurosurgery; University Medical Center; Ulm/Günzburg Germany
| | - K. Kohlmann
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - M. Janko
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - A.-K. Reuter
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - N. Keric
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - M. Nadji-Ohl
- Department of Neurosurgery Klinikum Stuttgart; Katharinenhospital; Stuttgart Germany
| | - J. König
- Division of Epidemiology and Health Services Research; Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - S. Singer
- Division of Epidemiology and Health Services Research; Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
- German Cancer Consortium (DKTK); Mainz Germany
| | - A. Giese
- Department of Neurosurgery; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
| | - M. Hechtner
- Division of Epidemiology and Health Services Research; Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes-Gutenberg-University; Mainz Germany
- German Cancer Consortium (DKTK); Mainz Germany
- German Cancer Research Center (DKFZ); Heidelberg Germany
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Pace A, Villani V, Parisi C, Di Felice S, Lamaro M, Falcicchio C, Bonucci A, Pugliese P, di Napoli A, Di Lallo D. Rehabilitation pathways in adult brain tumor patients in the first 12 months of disease. A retrospective analysis of services utilization in 719 patients. Support Care Cancer 2016; 24:4801-6. [DOI: 10.1007/s00520-016-3333-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/07/2016] [Indexed: 02/01/2023]
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Day J, Gillespie DC, Rooney AG, Bulbeck HJ, Zienius K, Boele F, Grant R. Neurocognitive Deficits and Neurocognitive Rehabilitation in Adult Brain Tumors. Curr Treat Options Neurol 2016; 18:22. [PMID: 27044316 DOI: 10.1007/s11940-016-0406-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Neurocognitive deficits are common with brain tumors. If assessed at presentation using detailed neurocognitive tests, problems are detected in 80 % of cases. Neurocognition may be affected by the tumor, its treatment, associated medication, mood, fatigue, and insomnia. Interpretation of neurocognitive problems should be considered in the context of these factors. Early post-operative neurocognitive rehabilitation for brain tumor patients will produce rehabilitation outcomes (e.g., quality of life, improved physical function, subjective neurocognition) equivalent to stroke, multiple sclerosis, and head injury, but the effect size and duration of benefit needs further research. In stable patients treated with radiotherapy +/- chemotherapy, the most frequent causes of distress include neurocognitive problems, psychological factors of anxiety, depression, fatigue, and sleep. Exercise, neurocognitive training, neurocognitive behavioral therapy, and medications to treat fatigue, behavior, memory, mood, and removal of drugs that may be associated with neurocognitive side effects (e.g., anti-epileptic drugs) all show promise in helping patients to manage the effects of their neurocognitive impairments better. As these are complex symptoms, multidisciplinary expertise is necessary to evaluate the influence of each variable to plan appropriate support and intervention. Neurocognitive rehabilitation should therefore occur in parallel with disease-centered, medical management from the outset. It should not occur in series, as a restricted phase in a patient's pathway. It should be considered in the pre- and post-operative period where there are good prospects of recovery, as one would for any brain-injured patient, so that the person may reach their optimal physical, sensory, intellectual, psychological, and social functional level. Yet the identification and selection of patients for early neurological rehabilitation and routine evaluation of cognition is uncommon in neurosurgical wards.
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Affiliation(s)
- Julia Day
- Department of Clinical Neuropsychology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - David C Gillespie
- Department of Clinical Neuropsychology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, Scotland, UK
| | - Helen J Bulbeck
- Brainstrust (the brain cancer people), Yvery Court, Castle Road, Cowes, Isle of Wight, PO31 7QG, UK
| | - Karolis Zienius
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - Florien Boele
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland, UK.
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Health-related quality of life in patients with high-grade gliomas: a quantitative longitudinal study. J Neurooncol 2015; 124:185-95. [PMID: 26026860 DOI: 10.1007/s11060-015-1821-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
The diagnosis of a high-grade glioma usual is followed by functional impairment(s), cognitive decline and an impaired psycho-social well-being. This might well have a significant and negative impact on the health related quality of life. The purpose of this study was to explore physical activity levels, prevalence and severity of anxiety and depressive symptoms and health-related quality of life among patients with a highgrade glioma. This paper is based on a longitudinal mixed methods study. Patients (n = 30) completed questionnaires at 5 time points from time of diagnosis until the final follow-up after 1 year. Scores of Karnofsky Performance Status (KPS), physical activity, anxiety and depression and health-related quality of life (FACT-Br) are obtained. Patients' physical activity level and KPS decrease during the disease- and treatment trajectory. The majority of patients did not report any depressive symptoms, eight individuals (26.7 %) being depressed at various time points. Among a sub-group of participants who completed all study requirements for the entire study period the level of anxiety decreased significantly during the study. The FACT-Br sub-scale of emotional well-being increased significant, indicating a better HRQOL attend of followup. The diagnosis of a HGG leads to an ongoing functional decline measured as a decline of the KPS and a reduced physical activity during leisure time. Supportive care combined with rehabilitative and palliative approaches might well be valuable along the trajectory especially during the post-surgery period when anxiety is at its highest peak.
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Hansen A, Rosenbek Minet LK, Søgaard K, Jarden JO. The effect of an interdisciplinary rehabilitation intervention comparing HRQoL, symptom burden and physical function among patients with primary glioma: an RCT study protocol. BMJ Open 2014; 4:e005490. [PMID: 25280804 PMCID: PMC4187655 DOI: 10.1136/bmjopen-2014-005490] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gliomas are among the biggest challenges in neurological and oncology rehabilitation and optimising treatment is of major clinical importance in this population. Although inpatient rehabilitation among glioma patients' results in improved functional measures, rehabilitation efforts are still not emphasised in this patient group and the literature lacks studies investigating the impact of outpatient rehabilitation. METHOD This protocol describes a randomised 6-week parallel group rehabilitation study investigating an outpatient interdisciplinary rehabilitation programme. The intervention consists of 6 weeks intensive physiotherapy as groups exercise in conjunction with 0-6 weeks of individual occupational therapy if a need is present. The aim of this study is to describe the design of the upcoming randomised control trial (RCT). The results of the RCT will add to the growing body of literature investigating the potential role of exercise as a supportive therapeutic intervention for a patient with cancer. ETHICS AND DISSEMINATION The project is approved by the Regional Scientific Ethical Committees for Southern Denmark under Project-ID: (S-20140108) and by the Danish Data Protection Agency (J. no.2008-58-0035). Dissemination will occur through presentation and findings will be published in peer-reviewed journals. The key strength of this study is its randomised design and it is the first study to investigate a standardised outpatient interdisciplinary rehabilitation programme among patients with glioma. A potential limitation is the uncertainty and risk of side effects to the concomitant treatment, which enhances the risk of dropout. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier NCT02221986.
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Affiliation(s)
- Anders Hansen
- Rehabilitation Unit, Odense University Hospital, Odense, Fyn, Denmark
| | | | - Karen Søgaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jens Ole Jarden
- Department of Neurology, Herlev University Hospital, University of Copenhagen, Copenhagen, Denmark
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Ownsworth T, Chambers S, Damborg E, Casey L, Walker DG, Shum DHK. Evaluation of the making sense of brain tumor program: a randomized controlled trial of a home-based psychosocial intervention. Psychooncology 2014; 24:540-7. [DOI: 10.1002/pon.3687] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/26/2014] [Accepted: 08/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
| | - Suzanne Chambers
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
- Cancer Council Queensland; Australia
- Health and Wellness Institute; Edith Cowan University; Australia
- Centre for Clinical Research; University of Queensland; Australia
| | - Ea Damborg
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
| | - Leanne Casey
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
| | - David G. Walker
- Newro Foundation and Briz Brain and Spine; Brisbane Australia
| | - David H. K. Shum
- School of Applied Psychology and Griffith Health Institute; Griffith University; Brisbane Australia
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Weller M, van den Bent M, Hopkins K, Tonn JC, Stupp R, Falini A, Cohen-Jonathan-Moyal E, Frappaz D, Henriksson R, Balana C, Chinot O, Ram Z, Reifenberger G, Soffietti R, Wick W. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 2014; 15:e395-403. [DOI: 10.1016/s1470-2045(14)70011-7] [Citation(s) in RCA: 435] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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