Life after surgical resection of a low-grade glioma: A prospective cross-sectional study evaluating health-related quality of life

Teng, Ken X; Price, Benjamin; Joshi, Shweta S; Alukaidey, Lobna; A, Shehab; Mansour, Kristy; Toor, Gurvinder S; Angliss, Rosemary; Drummond, Katharine J.

doi:10.1016/j.jocn.2021.03.038

Cited by 17 publications

(32 citation statements)

References 36 publications

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“…This situation may produce significant emotional distress for the patients due to fears regarding the treatment procedure, potential side effects, and unsatisfactory treatment outcomes including progression or recurrence of the glioma (7)(8)(9)(10)(17)(18)(19). These fears may lead to sleep problems that can significantly impair the patients' quality of life (11)(12)(13). Affected patients would likely benefit from near-term psychological support.…”

Section: Discussionmentioning

confidence: 99%

“…Assignment to a course of radiochemotherapy may cause significant distress for the patients who may be afraid particularly of the exposure to radiation and potential treatment-related adverse events (7-10). The distress may lead to sleep problems that can significantly impair the patients' quality of life and require psychological support already prior to the start of radiochemotherapy (11)(12)(13). Therefore, the present study investigated the prevalence and potential risk factors of pre-treatment sleep problems in patients with grade II to IV gliomas assigned to radiochemotherapy.…”

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confidence: 99%

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Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Kopelke

Kjær

Tvilsted

et al. 2021

In Vivo

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Background/Aim: Many patients with malignant gliomas are scheduled for radiochemotherapy, which may cause emotional distress associated with sleep problems. This study aimed to determine the prevalence of such sleep problems in these patients and identify risk factors. Patients and Methods: Fifty-seven patients scheduled for radiochemotherapy for grade II-IV gliomas were retrospectively investigated for pre-treatment sleep problems. Fifteen characteristics were evaluated including temporal relation to age, gender, performance status, comorbidity, (family) history of malignancies, distress score, emotional problems, physical problems, practical problems, involved sites, glioma grade, upfront surgery, and corticosteroids. Results: Nineteen patients stated pre-treatment sleep problems (prevalence=66.7%). Significant associations with sleep problems were found for female gender (p=0.023), presence of emotional problems (p=0.006), and ≥4 physical problems (p<0.001). A trend was found for distress scores ≥5 (p=0.077). Conclusion: The prevalence of sleep problems was high. Risk factors were determined that can be used to identify patients who likely benefit from psychological support.According to the classification of the World Health Organization (WHO), the group of gliomas includes four grades (grades I to IV), of which grade IV tumors (glioblastoma multiforme) are the most aggressive lesions with a 5-year survival rate of about 5% (1-3).Neurosurgical resection should be performed whenever safely possible. In patients with grade III or IV gliomas, resection is generally followed by radiochemotherapy (4-6). This applies also to selected patients with grade II gliomas, mainly after incomplete resection. Assignment to a course of radiochemotherapy may cause significant distress for the patients who may be afraid particularly of the exposure to radiation and potential treatment-related adverse events (7-10). The distress may lead to sleep problems that can significantly impair the patients' quality of life and require psychological support already prior to the start of radiochemotherapy (11)(12)(13). Therefore, the present study investigated the prevalence and potential risk factors of pre-treatment sleep problems in patients with grade II to IV gliomas assigned to radiochemotherapy. These data can contribute to the identification of patients who would likely benefit from psychological support beginning already prior to their course of radiochemotherapy. Patients and MethodsIn this retrospective study, 57 patients scheduled for radiochemotherapy of WHO grade II-IV gliomas were investigated with respect to pre-treatment sleep problems. These patients had completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer (14,15) between February 2019 and March 2021. The study was approved as a part of a larger project by the Ethics Committee of the University of Lübeck (reference 21-284). The technique to be used for the planned radiotherapy was volumetricmodulated arc therapy (VMAT). The preferred dose-frac...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Kopelke

Kjær

Tvilsted

et al. 2021

In Vivo

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“…Despite advances in intraoperative mapping techniques that have considerably reduced morbidity of resections (18,(24)(25)(26), their long-term morbidity has been little studied. Patients indeed generally show a decline in cognitive function and quality of life following surgery for gliomas (27,28). As a result, early/ larger resections could prematurely alter patients' neurologic/ cognitive function and quality of life in the period prior to disease progression, as compared with biopsies.…”

Section: Introductionmentioning

confidence: 99%

Early Surgery Prolongs Professional Activity in IDH Mutant Low-Grade Glioma Patients: A Policy Change Analysis

et al. 2022

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BackgroundUntil 2015, Dutch guidelines recommended follow-up and biopsy rather than surgery as initial care for suspected low-grade gliomas (LGG). Given evidence that surgery could extend patient survival, our center stopped following this guideline on January 1, 2010 and opted for early maximal safe resection of LGG. The effects of early surgery on the ability of patients to work remains little documented.MethodsA total of 104 patients operated on at our center between January 2000 and April 2013 and diagnosed with the WHO 2016 grade 2 astrocytoma, IDH mutant or oligodendroglioma, IDH mutant and deleted 1p19q were included. The clinical characteristics, survival, and work history of patients operated on before or after January 2010 were obtained from the patients’ records and compared. The minimal follow-up was 8 years.ResultsAs per policy change, the interval between radiological diagnosis and first surgery decreased significantly after 2010. Likewise, before 2010, 25.8% of tumors were initially biopsied, 51.6% were resected under anesthesia, and 22.5% under awake conditions versus 14.3%, 23.8%, and 61.9% after this date (p < 0.001). The severity of permanent postoperative neurological deficits decreased after 2010. In total, 82.5% of the patients returned to work postoperatively before 2010 versus 100% after 2010. The postoperative control of epilepsy increased significantly after 2010 (74.4% vs. 47.9%). The median time from diagnosis to a definitive incapacity to work increased by more than 2 years after 2010 (88.7 vs. 62.2 months).ConclusionA policy shift towards early aggressive surgical treatment of IDH mutant LGG is safe and prolongs the patients’ ability to work.

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“…Each of these tumours have extended post-operative survival but with risk of seizures and temporary or persistent neurological deficit, with significant HRQoL concerns. Our approach has been validated by the remarkable similarity in HRQoL outcomes in our research group’s meningioma [ 22 ] and low grade glioma [ 23 ] cohorts, with fatigue, sleep disturbance and perceived cognitive deficit topping the list of concerns for both tumour types. Nevertheless, there is still some heterogeneity of symptom burden experienced by patients with different tumour types (26), especially for symptoms such as fatigue and insomnia.…”

Section: Discussionmentioning

confidence: 99%

“…The use of more than one tumour type increased our sample size. Despite the heterogeneity of tumour types our approach has been validated by the remarkable similarity in HRQoL outcomes in our published MN [ 22 ] and LGG [ 23 ] cohorts. This is also true for AN patients in our cohort (manuscript in preparation).…”

Section: Methodsmentioning

confidence: 99%

Using machine learning to predict health-related quality of life outcomes in patients with low grade glioma, meningioma, and acoustic neuroma

2022

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Background Predicting reduced health-related quality of life (HRQoL) after resection of a benign or low-grade brain tumour provides the opportunity for early intervention, and targeted expenditure of scarce supportive care resources. We aimed to develop, and evaluate the performance of, machine learning (ML) algorithms to predict HRQoL outcomes in this patient group. Methods Using a large prospective dataset of HRQoL outcomes in patients surgically treated for low grade glioma, acoustic neuroma and meningioma, we investigated the capability of ML to predict a) HRQoL-impacting symptoms persisting between 12 and 60 months from tumour resection and b) a decline in global HRQoL by more than the minimum clinically important difference below a normative population mean within 12 and 60 months after resection. Ten-fold cross-validation was used to measure the area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (PR-AUC), sensitivity, and specificity of models. Six ML algorithms were explored per outcome: Random Forest Classifier, Decision Tree Classifier, Logistic Regression, K Neighbours Classifier, Support Vector Machine, and Gradient Boosting Machine. Results The final cohort included 262 patients. Outcome measures for which AUC>0.9 were Appetite loss, Constipation, Nausea and vomiting, Diarrhoea, Dyspnoea and Fatigue. AUC was between 0.8 and 0.9 for global HRQoL and Financial difficulty. Pain and Insomnia achieved AUCs below 0.8. PR-AUCs were similar overall to the AUC of each respective classifier. Conclusions ML algorithms based on routine demographic and perioperative data show promise in their ability to predict HRQoL outcomes in patients with low grade and benign brain tumours between 12 and 60 months after surgery.

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Life after surgical resection of a low-grade glioma: A prospective cross-sectional study evaluating health-related quality of life

Cited by 17 publications

References 36 publications

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Early Surgery Prolongs Professional Activity in IDH Mutant Low-Grade Glioma Patients: A Policy Change Analysis

Using machine learning to predict health-related quality of life outcomes in patients with low grade glioma, meningioma, and acoustic neuroma

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