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Bozzao A, Weber D, Crompton S, Braz G, Csaba D, Dhermain F, Finocchiaro G, Flannery T, Kramm C, Law I, Marucci G, Oliver K, Ostgathe C, Paterra R, Pesce G, Smits M, Soffietti R, Terkola R, Watts C, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care: Adult glioma. J Cancer Policy 2023; 38:100438. [PMID: 37634617 DOI: 10.1016/j.jcpo.2023.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCCs) are explanations of the organisation and actions necessary to provide high-quality care to patients with a specific cancer type. They are compiled by a working group of European experts representing disciplines involved in cancer care, and provide oncology teams, patients, policymakers and managers with an overview of the essential requirements in any healthcare system. The focus here is on adult glioma. Gliomas make up approximately 80% of all primary malignant brain tumours. They are highly diverse and patients can face a unique cognitive, physical and psychosocial burden, so personalised treatments and support are essential. However, management of gliomas is currently very heterogeneous across Europe and there are only few formally-designated comprehensive cancer centres with brain tumour programmes. To address this, the ERQCC glioma expert group proposes frameworks and recommendations for high quality care, from diagnosis to treatment and survivorship. Wherever possible, glioma patients should be treated from diagnosis onwards in high volume neurosurgical or neuro-oncology centres. Multidisciplinary team working and collaboration is essential if patients' length and quality of life are to be optimised.
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Affiliation(s)
- Alessandro Bozzao
- NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, Rome, Italy; School of Medicine and Psychology, "Sapienza" University - Rome, Rome, Italy; European Society of Oncologic Imaging (ESOI), Rome, Italy
| | - Damien Weber
- Paul Scherrer Institute, Center for Proton Therapy, Villigen, Switzerland; European Society for Radiotherapy and Oncology (ESTRO), Villigen, Switzerland
| | | | - Graça Braz
- European Oncology Nursing Society (EONS), Oporto, Portugal; Portuguese Oncology Institute, Outpatient Clinic Department, Oporto, Portugal
| | - Dégi Csaba
- International Psycho-Oncology Society (IPOS), Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Frederic Dhermain
- European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumour Group, Villejuif, France; Head of the Brain Tumor Board, Gustave Roussy University Hospital, Radiation Oncology, Villejuif, France
| | - Gaetano Finocchiaro
- Organisation of European Cancer Institutes (OECI), Milano, Italy; IRCCS Ospedale San Raffaele, Department of Neurology, Milano, Italy
| | - Thomas Flannery
- European Cancer Leagues (ECL), Belfast, Ireland; Royal Victoria Hospital Belfast, Department of Neurosurgery, Belfast, Ireland
| | - Christof Kramm
- The European Society for Paediatric Oncology (SIOPE), Goettingen, Germany; University Medical Center Goettingen, Division of Pediatric Hematology and Oncology, Goettingen, Germany
| | - Ian Law
- European Association of Nuclear Medicine (EANM), Copenhagen, Denmark; Rigshospitalet, Dept of Clinical Physiology, Nuclear Medicine & PET, Copenhagen, Denmark
| | - Gianluca Marucci
- European Society of Pathology (ESP), Milan, Italy; European Confederation of Neuropathological Societies (Euro-CNS), Milan, Italy; Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Rosina Paterra
- Fondazione IRCCS Istituto Neurologico Besta, Milano, Italy
| | - Gianfranco Pesce
- European School of Oncology (ESO), Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Marion Smits
- European Society of Radiology (ESR), Rotterdam, the Netherlands; Erasmus MC, Department of Radiology and Nuclear Medicine, University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Riccardo Soffietti
- European Academy of Neurology (EAN), Turin, Italy; University and City of Health and Science Hospital, Department of Neuro-Oncology, Turin, Italy
| | - Robert Terkola
- European Society of Oncology Pharmacy (ESOP), the Netherlands; University of Groningen, University Medical Centre Groningen, the Netherlands; University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, Gainesville, USA
| | - Colin Watts
- European Association of Neurosurgical Societies, Birmingham, UK; Neurosurgical Oncology Section, Institute of Cancer and Genomic Sciences, Birmingham, UK
| | | | - Philip Poortmans
- European Society for Radiotherapy and Oncology (ESTRO), Antwerp, Belgium; Iridium Netwerk and University of Antwerp, Antwerp, Belgium
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2
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Ernster AE, Body A, Deleyrolle P, St Clair J, Sampson D, Bacharz K, Yan SC, Melnick K, Allen A, Rahman M, Tran DD, Mitchell DA, Pereira DB, Ghiaseddin AP. Patterns and predictors of anxiety and depression symptom trajectories in patients diagnosed with primary brain tumors. J Neurooncol 2023; 164:701-710. [PMID: 37804375 PMCID: PMC10695656 DOI: 10.1007/s11060-023-04469-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Patients with primary brain tumors (pPBTs) often exhibit heightened distress. This study assesses how symptoms of anxiety and depression change over time in pPBTs and identifies factors that may predict patients' symptom trajectories. METHODS Ninety-nine adult pPBTs completed psychosocial assessments at neuro-oncology appointments over 6-18 months. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Brain; symptoms of anxiety and depression were assessed with the Patient-Reported Outcomes Measurement Information System short forms. The prevalence of patients with clinically elevated symptoms and those who experienced clinically meaningful changes in symptoms throughout follow-up were examined. Linear mixed-effects models evaluated changes in symptoms over time at the group level, and latent class growth analysis (LCGA) evaluated changes in symptoms over time at the individual level. RESULTS At enrollment, 51.5% and 32.3% of patients exhibited clinically elevated levels of anxiety and depression, respectively. Of patients with follow-up data (n = 74), 54.1% and 50% experienced clinically meaningful increases in anxiety and depression scores, respectively. There were no significant changes in anxiety or depression scores over time, but better physical, functional, and brain-cancer well-being predicted lower levels of anxiety and depression (p < 0.001). Five sub-groups of patients with distinct symptom trajectories emerged via LCGA. CONCLUSIONS pPBTs commonly experience elevated symptoms of anxiety and depression that may fluctuate in clinically meaningful manners throughout the disease. Routine screening for elevated symptoms is needed to capture clinically meaningful changes and identify factors affecting symptoms to intervene on.
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Affiliation(s)
- Alayna E Ernster
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | | | | | | | | | | | | | | | | | - David D Tran
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Ashley P Ghiaseddin
- University of Florida, Gainesville, FL, USA.
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Clinical Translational and Research Building, 2004 Mowry Road, PO Box 100219, Gainesville, FL, 32610, USA.
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3
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Park J, Park YG. Brain Tumor Rehabilitation: Symptoms, Complications, and Treatment Strategy. BRAIN & NEUROREHABILITATION 2022; 15:e25. [PMID: 36742081 PMCID: PMC9833490 DOI: 10.12786/bn.2022.15.e25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Brain tumors are receiving increasing attention in cancer rehabilitation due to their high rate of neurological deterioration. Motor dysfunction, cognitive deterioration, and emotional problems are commonly present in patients with brain tumors. Other medical complications, such as seizures, headache, and dysphagia are also common. An individualized multidisciplinary rehabilitation intervention is necessary to treat functional impairment due to the tumor itself and/or treatment-related dysfunction. Herein, we discuss rehabilitation treatment strategies in relation to the neurological and functional complications that commonly occur in patients with brain tumors.
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Affiliation(s)
- Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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4
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Sekely A, Zakzanis KK, Mabbott D, Tsang DS, Kongkham P, Zadeh G, Edelstein K. Long-term neurocognitive, psychological, and return to work outcomes in meningioma patients. Support Care Cancer 2022; 30:3893-3902. [PMID: 35041087 DOI: 10.1007/s00520-022-06838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study aimed to investigate long-term neurocognitive, psychological, and return to work (RTW) outcomes in meningioma patients, and to explore whether neurocognitive and psychological factors influence RTW outcomes in this population. METHODS In this retrospective study, 61 meningioma patients completed in-depth clinical neuropsychological assessments. Of these participants, 42 were of working-age and had RTW information available following neuropsychological assessment. Seventy-one percent and 80% of patients received radiation and surgery, respectively, with 49% receiving both radiation and surgery. Associations between demographic, medical, neurocognitive, psychological, and RTW data were analyzed using multivariable logistic regression analyses. RESULTS In our sample, 68% of patients exhibited global neurocognitive impairment, with the largest effect sizes found on tests of visual memory (d = 0.73), executive function (d = 0.61), and attention (d = 0.54). Twenty-seven percent exhibited moderate to severe levels of depressive symptoms. In addition, 23% and 30% exhibited clinically significant state and trait anxiety, respectively. Forty-eight percent of patients were unable to RTW. Younger age, faster visuomotor processing speed, and, unexpectedly, higher trait anxiety scores were associated with an increased likelihood of returning to work. CONCLUSIONS Meningioma patients are at risk of experiencing neurocognitive deficits, psychological symptoms, and difficulties returning to work. Our results suggest that neurocognitive and psychological factors contribute to RTW status in meningioma patients. Prospective research studies are necessary to increase our understanding of the complexity of functional disability in this growing population.
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Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada. .,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, ON, Canada.,Department of Psychology, Neurosciences, and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kongkham
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Kim Edelstein
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Ogez D, Péloquin K, Bertout L, Bourque CJ, Curnier D, Drouin S, Laverdière C, Marcil V, Aramideh J, Ribeiro R, Rondeau É, Sinnett D, Sultan S. “Taking back control together”: Definition of a new intervention designed to support parents confronted with childhood cancer. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1944476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- David Ogez
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Psychology, Université De Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université De Montréal, Québec
| | | | - Laurence Bertout
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Claude-Julie Bourque
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université De Montréal, Québec, Canada
| | - Daniel Curnier
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Kinesiology, Université De Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université De Montréal, Québec, Canada
| | - Valérie Marcil
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Nutrition, Université De Montréal, Québec, Canada
| | | | - Rebeca Ribeiro
- Department of Psychology, Université De Montréal, Québec, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université De Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Psychology, Université De Montréal, Québec, Canada
- Department of Pediatrics, Université De Montréal, Québec, Canada
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Dinapoli L, Chiesa S, Dinapoli N, Gatta R, Beghella Bartoli F, Bracci S, Mazzarella C, Sanfilippo MZ, Sabatino G, Gaudino S, Della Pepa GM, Frascino V, Valentini V, Balducci M. Personalised support of brain tumour patients during radiotherapy based on psychological profile and quality of life. Support Care Cancer 2021; 29:4555-4563. [PMID: 33479794 DOI: 10.1007/s00520-021-06000-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/12/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Psychological distress in primary malignant brain tumour (PMBT) patients is associated with poorer outcomes. Radiotherapy (RT) often induces side effects that significantly influence patients' quality of life (QoL), with potential impact on survival. We evaluated distress, anxiety, depression, and QoL over time to identify patients with difficulties in these areas who required more intense psychological support. METHODS Psychological questionnaires-Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy (FACT-G and FACT-Br)-were completed at the beginning (T0), in the middle (T1), directly after RT (T2), and 3 months after RT (T3). We personalised the psychological support provided for each patient with a minimum of three sessions ('typical' schedule) and a maximum of eight sessions ('intensive' schedule), depending on the patients' psychological profiles, clinical evaluations, and requests. Patients' survival was evaluated in the glioblastoma multiforme (GBM) patients, with an explorative intent. RESULTS Fifty-nine consecutive PMBT patients receiving post-operative RT were included. For patients who were reported as 'not distressed' at T0, no statistically significant changes were noted. In contrast, patients who were 'distressed' at T0 showed statistically significant improvements in DT, HADS, FACT-G, and FACT-Br scores over time. 'Not distressed' patients required less psychological sessions over the study duration than 'distressed' patients. Interestingly, 'not distressed' GBM patients survived longer than 'distressed' GBM patients. CONCLUSIONS Increased psychological support improved distress, mood, and QoL for patients identified as 'distressed', whereas psychological well-being was maintained with typical psychological support in patients who were identified as being 'not distressed'. These results encourage a standardisation of psychological support for all RT patients.
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Affiliation(s)
- Loredana Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Unità Operativa Semplice di Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Nicola Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Roberto Gatta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Ciro Mazzarella
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Giovanni Sabatino
- Dipartimento di Neurochirurgia, Ospedale Mater Olbia, Olbia, Italy.,Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Gaudino
- UOC di Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Maria Della Pepa
- UOC di Neurochirurgia, Dipartimento Scienze dell'invecchiamento, Neurologiche, Ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Frascino
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Balducci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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7
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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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