Psychosocial functioning and quality of life in patients with primary brain tumors

Abstract

Perceived quality of life (QOL) was evaluated in a group of 50 patients with primary brain tumors. Participants completed two QOL measures and a demographic profile. Age was found not to be an important factor in differentiating QOL in these patients. All areas of QOL were found to be affected adversely by one or more of five factors: being female, being divorced, having bilateral tumor involvement, having received chemotherapy, and having a poor performance status. Pearson product-moment correlations conducted on the subscale and total scores of the two QOL instruments revealed that the two scales measure different QOL aspects and overlap in only a few areas. This may be related to the different measurement paradigms that these two instruments represent. This study is one of the first to evaluate the multidimensional aspects of QOL in patients with primary brain tumors, an understudied group. A prospective study of QOL in this group, already underway at the authors' institution, is needed to evaluate comprehensively the effect of different treatments and interventions on the QOL functioning of primary brain tumor patients. Additionally, this study shows that the choice of QOL instruments is very important and needs to be driven by the research question.

Quality of life in patients with brain tumor: what's relevant in our quest for therapeutic efficacy

“…In some of these instruments, one important aspect of QOL assessment is the evaluation of the importance respondents attach to each of the domains assessed; in other words, a utility-type evaluation. [69,70] These investigations provide some indication that this combined instrumentation is more sensitive in assessing QOL than the KPS, especially in patients who function independently (KPS score > 70). In the quest for more responsive and comprehensive QOL measurement, one, of course, confronts the dilemma of obtaining reliable and accurate self-reports from patients who are cognitively impaired because of their tumors and/or related treatments, and additional work is needed to address this challenge.…”

“…[12,13,18,28,35] The toxicity of therapy has also been assessed, for the most part, in categorical terms such as "major" or "minor" morbidity and mortality. [8,9,11] Although a number of investigators have attempted to evaluate cognitive and psychosocial function, [1,23,24,60,66,69,70] relatively few reports of these evaluations appear in current literature. In the second major use of QOL measures--selection of patients to be included in a clinical trial [61]--physical outcome measures have been used predominantly [6,28,54,59,65] (Table 1).…”

“…These deficits can only be detected with QOL measures that more specifically evaluate these functions in brain tumor patients. [24,69,70] On the other hand, several investigators have confirmed the interrater reliability [50,72] and the construct and predictive validity, [36,49,50,54] of the KPS and support its use as a valid measure of the key QOL dimension of well-being. [36] …”

“…A combined strategy has worked effectively, in which a well-validated generic instrument is combined with a disease-specific inventory of supplementary measures in many disease groups. [48] Several investigators have used multidimensional instruments to assess the QOL in patients with malignant brain tumors [36,44,69,70] with core generic instruments such as the European Organization for Research and Treatment of Cancer QLQ-C, [30,36,44,58] the Functional Assessment of Cancer Therapy scale, [70] or the Medical Outcomes Study Short-Form Health Survey measures (20-and 36-item forms) [40] supplemented by specific measures for brain tumor patients. In some of these instruments, one important aspect of QOL assessment is the evaluation of the importance respondents attach to each of the domains assessed; in other words, a utility-type evaluation.…”

Neurocognitive functioning and quality of life in patients with recurrent malignant gliomas treated on a phase Ib trial evaluating topotecan by convection-enhanced delivery

“…6 -9 Additionally, patients with brain tumors are generally more incapacitated than those with systemic disease, which can significantly affect QoL. 10 The aggressive nature and toxicity of treatments undergone by brain-tumor patients make assessments of QoL especially important and may influence decision-making of both patients and physicians. 6,11 Given the poor prognosis for this patient population, the development of surrogate treatment strategies is imperative.…”