Health related quality of life (HRQOL) in long-term survivors of pediatric low grade gliomas (LGGs)

Abstract

BACKGROUND The purpose of this study was to assess the health-related quality of life (HRQOL) and the impact of treatment on HRQOL in long-term survivors of pediatric low-grade gliomas (LGGs) using an adult instrument. METHODS QOL of 121 patients with a diagnosis of LGG from the Mayo Clinic were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30 for cancer in general) and (EORTC QLQ-BN20 specific for brain tumors). RESULTS Median follow-up was 21.9 years for the participants. Median age at diagnosis was 11.8 years and at assessment was 33 years. Mean (standard deviation) global QOL score for the study was 78 (18) and 76.4 (22.8) in a reference population of healthy adults. Using QLQ-C30, radiation treated patients compared to non-radiation patients reported lower physical functioning (p=0.002), role functioning (p=0.004), and more constipation problems (p<0.001). Patients with tumor recurrence reported lower role functioning (p=0.016), social functioning (p=0.040), and more financial problems (p=0.029) compared to their counterparts. Using QLQ-BN20, patients with deep tumors compared to cortical tumors reported more bladder control problems (p=0.016). Radiation treated patients also reported more bladder control problems (p<0.001) compared to their counterparts. In the multivariable analysis, radiation therapy remained an independent predictor of physical and role functioning as well as symptoms related to brain tumors like visual disorders and motor dysfunction. CONCLUSION Global QOL of long-term survivors of pediatric LGGs is similar to that of a reference population of healthy adults. The following tumor and treatment related factors were most consistently associated with poorer QOL: CNS tumor location, post-operative radiation, and tumor recurrence. Future studies are necessary to identify strategies to improve QOL in this subgroup of patients.

Systematic review and meta‐analysis of health‐related quality of life in pediatric CNS tumor survivors

“…Of 46 studies that included a comparison or control group, 23 included healthy comparisons, peers, or siblings and 21 included other cancer survivors. Of the 23 studies that included a comparison to healthy controls, peers, or siblings, 11 did not report necessary statistics for either the control group or for pediatric CNS tumor survivors, and four only reported outcomes for subscales of their tools . In total, 12 studies were considered eligible for the meta‐analysis …”

“…26,28,30,31,36 Importantly, the majority of studies reporting improved HRQOL over time were in the context of an intervention study (e.g., Head Start). the control group or for pediatric CNS tumor survivors, [38][39][40][41][42][43][44][45][46][47][48] and four only reported outcomes for subscales of their tools. [49][50][51][52] In total, 12 studies were considered eligible for the meta-analysis.…”

Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

“…Health-related quality-of-life scores were compared to scores for the healthy population, 13 scores for glioma and metastatic brain cancer patients, 4,16,26 and scores for long-term survivors of pediatric gliomas, which included WHO grade I (57%) and II (43%) tumors of various locations (Tables 2 and 3). 22 In comparison to the healthy controls, tectal glioma patients had presented significant differences in scores for emotional functioning (mean 77.3 vs 32.2, p < 0.01), cognitive functioning (75.8 vs 90.5, p < 0.01), social functioning (68.2 vs 31.5, p < 0.01) and financial difficulties (18.2 vs 5.7, p < 0.01) (Tables 2 and 3). 13 When compared to a general cohort of patients with newly diagnosed high-grade glioma (n = 745, two phase III EORTC/NCIC trials), 26 tectal glioma patients scored significantly better regarding future uncertainty (18.8 vs 37.0, p < 0.05), seizures (0.0 vs 60.1, p < 0.01) but worse for bladder dysfunction (36.0 vs 8.4, p < 0.01).…”

Management of Gliomas: Overview of the Latest Technological Advancements and Related Behavioral Drawbacks

“…Those are now emerging clinical issues as the general lack of comprehensive neuropsychological assessment performed preoperatively and in the acute postoperative period has prompted neurosurgeons to reconsider the need for cognitive assessment in the course of treatment [ 9 ]. Landmark papers published over the last 5 years on this topic are reported in Table 1 for HGG [ 16 – 22 ] and Table 2 for LGG [ 23 – 27 ]. The progressive, almost exponential, growth in terms of papers published on QoL is undoubtedly the best parameter to understand the increased interest in the neurooncology community toward this argument.…”