Disease‐Specific Quality of Life in Vestibular Schwannoma: A National Cross‐sectional Study Comparing Microsurgery, Radiosurgery, and Observation

Abstract

Objective To examine the impact of treatment on disease-specific health-related quality of life (HRQOL) among patients with sporadic vestibular schwannoma (VS). Study Design National cross-sectional study. Setting Tertiary referral center and the Acoustic Neuroma Association. Subjects and Methods Adult patients with VS who completed the Penn Acoustic Neuroma Quality of Life (PANQOL) survey. Patients were classified by treatment at the most recent survey as microsurgery, radiosurgery, observation, or recently diagnosed (RD). PANQOL scores were compared among VS treatment groups and with nontumor controls using analysis of covariance. Results A total of 1362 respondents with VS were analyzed. Total PANQOL scores differed significantly by treatment ( P = .024) with adjusted means of 60, 63, 65, and 62 for the microsurgery, radiosurgery, observation, and RD groups, respectively. Subdomain scores for facial function, balance, hearing loss, and pain differed significantly ( P < .05) by treatment. Comparisons that surpassed thresholds for clinical significance included microsurgery compared to radiosurgery and observation for facial function, microsurgery compared to observation and RD for hearing loss, and microsurgery compared to radiosurgery and observation for pain. Subdomain scores for anxiety, facial function, balance, hearing loss, energy, and pain and total PANQOL scores for nontumor controls were significantly higher (ie, more favorable) compared to the VS groups ( P < .05). General health scores did not differ significantly between the nontumor controls and the VS groups ( P = .19). Conclusion Differences in HRQOL among treatment modalities are small and variably exceed the minimal clinically important difference. The impact of a VS diagnosis on HRQOL supersedes that of the treatment type.

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

“…On top of that, 71% of the patients reported to have received active treatment in our study while a large population-based study by Reznitsky et al shows that 48.4% of 3637 patients were actively treated during a mean 7.33 years of follow-up [ 45 ], limiting the generalizability of our results. However, when looking at questionnaire studies in the field of VS, actively treated patients tend to respond more to surveys (70.3–72.5%), comparable to our findings [ 3 , 27 , 46 ]. Yet patients who were actively treated might have had larger tumours upfront with more complaints and a higher burden, though there is a limited relation with tumour size or growth and for example hearing loss [ 47 ].…”

Long-term quality of life outcomes in patients undergoing microsurgical resection of vestibular schwannoma

“…While most studies utilizing PANQOL have assessed how treatment modality impacts QOL in patients with VS, 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 we sought to determine the specific baseline characteristics and surgical outcomes that influence the QOL of patients who undergo microsurgical resection. Expectedly, we identified that functional outcomes, such as hearing preservation and HB grade, had a significant impact on self-reported scores within the hearing and facial domains.…”

“…The PANQOL questionnaire has been applied in several studies analyzing QOL outcomes in patients between different VS treatment groups, such as microsurgery, stereotactic radiosurgery, and observation, and authors have suggested various factors that influence patient QOL. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Here, we utilize the PANQOL questionnaire in patients who elected to receive microsurgical resection of VS to determine the baseline and surgical characteristics that most significantly impact QOL outcomes. The present study not only analyzes QOL outcomes in a large microsurgical cohort, but also provides analysis of how facial and hearing preservation, extent of resection, and retreatment vary in their association with QOL outcomes.…”

Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five

“…The diagnosis of VS, as opposed to treatment modality chosen, seems to have the biggest impact on the quality of life. 21 22 Symptoms most influential on lowering quality of life were ongoing headaches and dizziness with facial nerve function and hearing loss less siginficant. 23 Patients experience improved quality of life following GTR as compared with having residual tumor.…”