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Pruijn IMJ, Parmaksiz M, Verheul JB, Mulder JJS, Kievit W, Kunst HPM. Health-Related Quality of Life in Patients With a Stable or Growing Vestibular Schwannoma Managed by Wait and Scan or Stereotactic Radiosurgery. Otolaryngol Head Neck Surg 2024; 171:823-832. [PMID: 38769852 DOI: 10.1002/ohn.814] [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: 01/23/2024] [Revised: 03/17/2024] [Accepted: 04/06/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To assess the effect of wait and scan (W&S) and stereotactic radiosurgery (SRS) on health-related quality of life (HRQoL) over time in patients with a stable vestibular schwannoma (VS) and growing VS. STUDY DESIGN Longitudinal, multicenter, observational study. SETTING Tertiary expert center for VS (Radboudumc Nijmegen) and Gamma-Knife center ETZ Hospital Tilburg. METHODS Changes in HRQoL, measured with the Penn Acoustic Neuroma Quality-of-Life (PANQOL), and the physical and mental component summary scores (PCS and MCS, respectively) derived from the 36-Item Short Form Health Survey (SF-36), were compared among patients managed by W&S and SRS between 2017 and 2022. Second, HRQoL over time in patients with a growing VS was compared between W&S and SRS. RESULTS Differences in PANQOL total and subdomain scores, PCS and MCS scores over time in the W&S (n = 73) and SRS (n = 170) groups were nonsignificant and on average did not exceed the minimal clinically important differences (mean difference of -2.56 [PANQOL total], 1.22 [PCS], and -1.76 [MCS]; all P > .05). In growing VS, comparison of W&S (n = 29) and SRS (n = 154) also revealed no significant difference (mean difference of 1.19 (PANQOL total), 1.83 (PCS) and -0.12 (MCS); all P > .05). CONCLUSION Differences in HRQoL in patients with VS are minor and not significantly different or clinically relevant between patients managed with W&S or SRS. Similarly, patients with a growing VS managed with W&S or SRS exhibit no significant or clinical relevant difference in HRQoL during follow-up. This can aid clinicians in the counseling of patients regarding HRQoL when deciding on a management strategy after diagnosis or documented growth.
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Affiliation(s)
- Ineke M J Pruijn
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
| | - Merve Parmaksiz
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen B Verheul
- Department of Neurosurgery, Gamma Knife Center, ETZ Hospital, Tilburg, The Netherlands
| | - Jef J S Mulder
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
| | - Wietske Kievit
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, The Netherlands
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
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Tavares MP, Bahmad Jr F. Hearing Function after CyberKnife for Vestibular Schwannoma: A Systematic Review. Int Arch Otorhinolaryngol 2024; 28:e543-e551. [PMID: 38974623 PMCID: PMC11226254 DOI: 10.1055/s-0044-1787736] [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: 10/08/2022] [Accepted: 04/19/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction CyberKnife (CK) radiosurgery is a treatment strategy for vestibular schwannoma (VS). Objectives To evaluate hearing preservation (HP) after CK for VS. Data Synthesis The study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, and it was registered at the International Prospective Register of Systematic Reviews (PROSPERO, under number CRD42021250300). The inclusion criteria were based on the population, intervention, comparison, outcome, timing and study design (PICOTS) strategy: population - patients with VS; intervention - CK; Comparison - none; Outcome - serviceable HP defined by Gardner and Robertson as grades I or II, or by the American Academy of Otolaryngology and Head and Neck Surgery as classes A or B; timing - mean follow-up longer than 1 year; and study design - retrospective or prospective studies. The exclusion criteria were: studies not published in English; studies published before January 2000 and after October 2021; and studies only including patients with neurofibromatosis type 2 or submitted to a previous treatment. The PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, LILACS, and IBECS databases were used and last searched on October 27th, 2021. Statistical heterogeneity was assessed using I 2 statistics. The appraisal checklist was used to assess the risk of bias in the included studies. A total of 222 studies were analyzed, and 13 were included in the synthesis, which represents 493 participants with serviceable hearing before intervention. The mean HP rate after CK using a random effects model was of 68% (95% confidence interval [95%CI]: 59-76%) at a mean follow-up of 42.96 months. Conclusion The longer follow-up period was associated with a lower HP rate after CK radiosurgery for VS in the qualitative synthesis.
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Affiliation(s)
- Matheus Pedrosa Tavares
- Postgraduate Program in Health Sciences, School of Medicine, Universidade de Brasília, Brasília, DF, Brazil
| | - Fayez Bahmad Jr
- Postgraduate Program in Health Sciences, School of Medicine, Universidade de Brasília, Brasília, DF, Brazil
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Pruijn IMJ, van Heemskerken P, Kunst HPM, Tummers M, Kievit W. Patient-preferred outcomes in patients with vestibular schwannoma: a qualitative content analysis of symptoms, side effects and their impact on health-related quality of life. Qual Life Res 2023; 32:2887-2897. [PMID: 37258945 PMCID: PMC10474211 DOI: 10.1007/s11136-023-03433-x] [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] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE During counseling and management of patients with vestibular schwannoma (VS), the emphasis is shifting from tumour control and nerve preservation towards maintaining or improving health-related quality of life (HRQoL). Understanding the patients' perspective and impact of VS is, therefore, of utmost importance. The current study aimed to identify treatment outcomes preferred by patients and to explore the patient-reported VS symptoms and management-related side effects and their impact on HRQoL. METHODS Patients with VS were contacted through the Dutch VS association Stichting Hoormij and questioned using a semi-structured, cross-sectional online survey. Patients were asked to report and rank symptoms and side effects, with their impact on HRQoL and frequency of occurrence. Results were structured through qualitative content analysis. Coded symptoms, side effects, impacts, frequencies, and patient-preferred outcomes were analysed and summarized with descriptive statistics. RESULTS Of the 231 respondents, 71% were actively treated. Hearing (symptoms vs. side effects: 78.8% vs. 63.6%), balance (62.3%; 48.8%), and energy issues (33.8%; 32.6%) were the most frequently mentioned symptoms and management-related side effects. Fatigue, deafness, headaches, and hearing loss had the highest impact on HRQoL. The majority of patients identified hearing preservation (61%), balance preservation (38.5%), and reduced tinnitus (34.6%) to be the patient-preferred outcomes. CONCLUSION This qualitative study demonstrates that in this population many patients with VS encounter participation difficulties in their daily physical and social activities and value hearing and balance preservation, reduced tinnitus, and restored energy as preferred outcomes as they are hampered by symptoms and side effects related to hearing, balance, and energy. Healthcare professionals should consider these key points and use these and the patient-preferred outcomes in consultation, shared decision making, treatment, and follow-up to optimize patient-centred care.
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Affiliation(s)
- Ineke M J Pruijn
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands.
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands.
| | - Phylisha van Heemskerken
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6525 EX, Nijmegen, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center, Nijmegen/Maastricht, The Netherlands
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcia Tummers
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department of Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Machetanz K, Lee L, Wang SS, Tatagiba M, Naros G. Trading mental and physical health in vestibular schwannoma treatment decision. Front Oncol 2023; 13:1152833. [PMID: 37434979 PMCID: PMC10332305 DOI: 10.3389/fonc.2023.1152833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Observation, radiotherapy and surgery are treatment options in vestibular schwannomas (VS). Decision making differs between centers and is usually based on tumor characteristics (e.g., size) and the expected physical health (PH) outcome (i.e., hearing and facial function). However, mental health (MH) is often under-reported. The objective of the present study was to ascertain the impact of VS treatment on PH and MH. Methods PH and MH were assessed in a prospective cross-sectional study including 226 patients with unilateral sporadic VS before and after surgical removal (SURG). Quality-of-life (QoL) was estimated by self-rating questionnaires: general Short-Form Health Survey (SF-36), Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), Dizziness Handicap Inventory (DHI), Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), and Facial Disability Index (FDI). QoL changes over time as well as predictive factors were accessed by multivariate analyses of covariance (MANCOVA). Results In total, 173 preoperative and 80 postoperative questionnaires were analyzed. There was a significant PH deterioration related to facial function (FDI, PANQOL-face) after surgery. In line with facial rehabilitation, however, FDI improved within the first five years after surgery and did not differ compared to the preoperative patient cohort, eventually. In contrast, MH (i.e., PANQOL-anxiety) and general health (i.e., PANQOL-GH) improved with surgery and correlated with the extent-of-resection. Conclusion Physical and mental health is significantly influenced by VS surgery. While PH might decrease after surgery, MH potentially increases when patient is cured. Practitioners should take MH into account before advising an incompletely VS treatment (e.g., subtotal resection, observation or radiosurgery).
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Affiliation(s)
- Kathrin Machetanz
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Larissa Lee
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie S Wang
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
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Ma HJ, Orozco FR, Raj CK, Herrera K, Parsons JC, Kim I, Hur K. Effects of Language, Age, and Hearing Loss on Health-Related Quality of Life. OTO Open 2023; 7:e55. [PMID: 37251543 PMCID: PMC10225048 DOI: 10.1002/oto2.55] [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: 09/30/2022] [Revised: 04/14/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023] Open
Abstract
Objective To understand the effect of age on health-related quality of life (HRQoL) in patients with hearing loss and determine how primary language mediates this relationship. Study Design Cross-sectional study. Setting General otolaryngology clinic in Los Angeles. Methods Demographics, medical records, and HRQoL data of adult patients presenting with otology symptoms were reviewed. HRQoL was measured using the Short-Form 6-Dimension utility index. All patients underwent audiological testing. A path analysis was performed to generate a moderated path analysis with HRQoL as the primary outcome. Results This study included 255 patients (mean age = 54 years; 55% female; 27.8% did not speak English as a primary language). Age had a positive direct association with HRQoL (p < .001). However, the direction of this association was reversed by hearing loss. Older patients exhibited significantly worse hearing (p < .001), which was negatively associated with HRQoL (p < .05). Primary language moderated the relationship between age and hearing loss. Specifically, patients who did not speak English as a primary language had significantly worse hearing (p < .001) and therefore worse HRQoL (p < .01) than patients who spoke English as a primary language with hearing loss. Increasing age was associated with bilateral hearing loss compared to unilateral hearing loss (p < .001) and subsequently lower HRQoL (p < .001). Polypharmacy (p < .01) and female gender (p < .01) were significantly associated with lower HRQoL. Conclusion Among otolaryngology patients with otology symptoms, older age and not speaking English as a primary language were associated with worse hearing and subsequently lower HRQoL.
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Affiliation(s)
- Harrison J. Ma
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Francis Reyes Orozco
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Christine K. Raj
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kevin Herrera
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John C. Parsons
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ian Kim
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kevin Hur
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Neve OM, Jansen JC, Koot RW, Ridder MD, Paul G van Benthem P, Stiggelbout AM, Hensen EF. Long-Term Quality of Life of Vestibular Schwannoma Patients: A Longitudinal Analysis. Otolaryngol Head Neck Surg 2023; 168:210-217. [PMID: 35349360 DOI: 10.1177/01945998221088565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Vestibular schwannoma management aims to maintain optimal quality of life (QoL) while preventing severe sequelae of the tumor or its treatment. This study assessed long-term QoL of patients with vestibular schwannoma in relation to treatment modality and decisional regret. STUDY DESIGN A longitudinal study, in which clinical and QoL data were used that were cross-sectionally acquired in 2014 and again in 2020 from the same patient group. SETTING A tertiary expert center for vestibular schwannoma care in the Netherlands. METHODS QoL was measured by the Penn Acoustic Quality of Life (PANQOL) scale. Changes in time were assed using a linear mixed model. In addition, the Decision Regret Scale was analyzed. RESULTS Of 867 patients, 536 responded (62%), with a median follow-up of 11 years. All PANQOL subdomain scores remained stable over time and did not exceed minimal clinically important difference (MCID) levels. Time since treatment did not affect QoL. Patients had comparable average QoL scores and proportions of patients with changing QoL scores (ie, exceeding the MCID) over time, irrespective of the received initial treatment. Female patients and those who required salvage therapy (either by radiotherapy or surgery) reported a lower QoL. The latter patient group reported the highest decisional regret. CONCLUSION On average, the long-term QoL of patients with vestibular schwannoma is comparable for patients under active surveillance and those who have received active treatment, and it remains stable over time. This suggests that, on average, preservation of QoL of patients with vestibular schwannoma is feasible when adequately managed.
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Affiliation(s)
- Olaf M Neve
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Radboud W Koot
- Department of Neurosurgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Mischa de Ridder
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
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