Evaluating patients for psychosocial distress and supportive care needs based on health-related quality of life in primary brain tumors: a prospective multicenter analysis of patients with gliomas in an outpatient setting

Abstract

The association between health-related quality of life (HRQoL), psychosocial distress, and supportive care is in the focus of patient-centered neuro-oncology. We investigated the relationship between the aforementioned in glioma-patients to evaluate the association of these instruments and determine cut-off values for suitable HRQoL scales indicating a potential need for intervention. In an observational multi-center study, outpatients completed the Distress Thermometer (DT), EORTC Quality of Life Questionnaire (EORTC-QLQ-C30/BN20, HRQoL), and Supportive-Care-Needs-Survey-SF34-G (SCNS). Based on nine EORTC-function and selected -symptom scales items of the questionnaires were matched. Convergent validity of related single items and scores across the instruments was estimated. EORTC cut-off values were calculated. Data of 167 patients were analyzed. The strongest correlation of EORTC-QLQ-C30 and DT was found for cognitive function (cogf), global health status (GHS), emotional (emof), role function (rolef), future uncertainty (FU), fatigue, and between EORTC-QLQ-C30 and SCNS for FU, emof, rolef (r = |0.4-0.7|; p < 0.01). EORTC cut-off values of <54.2 (GHS/QoL) and <62.5 (emof) predicted a DT ≥ 6 (AUC 0.79, 0.85, p < 0.01). EORTC cut-off values of <70.8 (emof) and <52.8 (FU) predicted the need for supportive care (AUC 0.78, 0.85; p < 0.01). Worse EORTC-C30 scores correlate with higher DT and SCNS scores. With this exploratory assessment, cut-off values for EORTC-C30 subscores to predict distress and pathological SCNS-scores could be determined, which could influence patients' referral to further treatment. However, further prospective clinical trials are needed to confirm the clinical relevance of these cut-off values.

Thresholds for clinical importance were established to improve interpretation of the EORTC QLQ-C30 in clinical practice and research

“…Other studies have attempted to define thresholds for the QLQ-C30 using ad hoc criteria. Hickmann et al [11] developed thresholds for six functioning and symptom domains using distress and supportive care needs separately as criteria. For the latter criterion, Hickmann et al reported the same thresholds for RF, CF, and SF as in our study, whereas thresholds for PF and FA were higher.…”

Correlation of psychooncological distress- screening and quality of life assessment in neurosurgical patients

“…Here, we concentrated on striking results regarding superordinate aspects of the questionnaire like global health, future uncertainty and QOL based on the following considerations: (1) to keep the evaluation as simply and suitable for daily use as possible (1) because of our inclusion criteria next to brain tumors our patients comprised different neurosurgical diagnoses, therefore we neglected brain tumor specific aspects (2) at the time of assessment our patients presented a median KPS of 90 without major neurologic deficits, thus we did not pay attention toward special functional and symptom scales. Additionally, a recent analysis highlighted future uncertainty and global health status especially in brain tumor patients as very important and correlated with unmet needs in these patients [ 15 ].…”

“…In a larger multicenter study Hickmann et al presented data of 167 neurooncological outpatients analyzing results of the distress thermometer, the EORTC QLQ-C30/BN 20 as well as the Supportive- Care-Needs- Survey- SF34-G (SCNS). They observed a strong correlation of elevated distress and fatigue, cognitive- emotional function, global health status and future uncertainty [ 15 ].…”

Glioma patients in outpatient care - Optimization of psychosocial care in neuro-oncological patients (GLIOPT): Protocol for a cluster randomized controlled trial.

“…We conducted several observational studies before that led to the research question of the GLIOPT trial. Hereby we found that 1) some questionnaires do not fit to the requirements of HGG patients (6,11), 2) patients in reduced clinical condition with high unmet needs may be missed by a questionnaire or tablet assessment (8,12) and 3) we can use "signaling items" probably indicating patients in need of support (13). Applying these items in a face-to-face conversation of doctor and patient was possible.…”