Resilience in Lower Grade Glioma Patients

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Gliomas are a group of heterogeneous tumors that account for substantial morbidity, mortality, and costs to patients and healthcare systems globally. Survival varies considerably by grade, histology, biomarkers, and genetic alterations such as IDH mutations and MGMT promoter methylation, and treatment, but is poor for some grades and histologies, with many patients with glioblastoma surviving less than a year from diagnosis. The present review provides an introduction to glioma, including its classification, epidemiology, economic and humanistic burden, as well as treatment options. Another focus is on treatment recommendations for IDH-mutant astrocytoma, IDH-mutant oligodendroglioma, and glioblastoma, which were synthesized from recent guidelines. While recommendations are nuanced and reflect the complexity of the disease, maximum safe resection is typically the first step in treatment, followed by radiotherapy and/or chemotherapy using temozolomide or procarbazine, lomustine, and vincristine. Immunotherapies and targeted therapies currently have only a limited role due to disappointing clinical trial results, including in recurrent glioblastoma, for which the nitrosourea lomustine remains the de facto standard of care. The lack of treatment options is compounded by frequently suboptimal clinical practice, in which patients do not receive adequate therapy after resection, including delayed, shortened, or discontinued radiotherapy and chemotherapy courses due to treatment side effects. These unmet needs will require significant efforts to address, including a continued search for novel treatment options, increased awareness of clinical guidelines, improved toxicity management for chemotherapy, and the generation of additional and more robust clinical and health economic evidence.

Resilience of Patients With Brain Tumor While Awaiting Surgery

ABSTRACT

BACKGROUND: Resilience is the ability of patients to adapt effectively when given a diagnosis of an illness. While awaiting brain tumor surgery, patients often experience uncertainty from brain tumor-related symptoms resulting in inducing depressive symptoms, having physical disability, and reducing quality of life. Resilience studies have been widely conducted in the postoperative phase with a limited knowledge on the preoperative phase. This study aimed to identify predictors of resilience while awaiting brain tumor surgery. METHODS: This cross-sectional predictive study includes 100 participants 18 years and older, with diagnosis of brain tumors, and waiting for brain tumor surgery at the outpatient department of 1 tertiary hospital in Bangkok between August 2022 and February 2023. Multiple linear regression was used to examine the predictors of resilience. RESULTS: Most of the sample (77%) were female with a mean age of 52.71 (13.17) years. The most common type of brain tumor was meningioma (38%). The median waiting time since brain tumor diagnosis until the date of preadmission for operation was 18 (3-1464) days. Symptom severity, social support, and treatment plan were able to explain 37.3% of the variance of resilience in patients awaiting brain tumor surgery ( F = 19.077, P < .01, R2 = 0.373, adjusted R2 = 0.354). CONCLUSION: Resilience is an important skill for patients with brain tumor to manage uncertainty events that occur in their lives. The preoperation phase needs to assess both physical and mental tumor-related symptoms, and include caregivers as part of the care, to promote resilience skill for patients awaiting brain tumor surgery.

Association between stigma and sleep quality in patients with breast cancer: A latent profile and mediation analysis

PURPOSE

This study aims to identify the heterogeneity in the stigma experienced by patients with breast cancer and examine the mediation effect of resilience on the relation between stigma and sleep quality.

METHOD

A total of 396 patients with breast cancer were enrolled from Be Resilient to Breast Cancer (BRBC) program between January and April 2023. Participants completed the Social Impact Scale, the 10-item Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index Scale. Latent profile analysis (LPA) and mediation analysis were conducted to analyze the data.

RESULTS

LPA categorized stigma into three subgroups, namely low-stigma (21.9%), moderate-stigma (64.9%), and high-stigma (13.2%). Mediation analysis revealed a fully mediated effect in the comparison between low-stigma and moderate-stigma groups (standard error [SE] = 0.13, 95%CI = 0.06,0.56), whereas a partially mediated effect was observed in the comparison between low-stigma and high-stigma groups (SE = 0.18, 95%CI = 0.39,1.10).

CONCLUSIONS

Stigma is a significant factor to sleep quality in breast cancer and resilience could act as a robust buffer against stigma resulting in improved sleep quality. Resilience-based interventions might be helpful in this population.