Quality of Life (QoL) as Predictive Mediator Variable for Survival in Patients with Intracerebral Neoplasma During Radiotherapy

Sehlen, Susanne; Lenk, Markus; Hollenhorst, H.; Schymura, Beatrice; Aydemir, Ülker; Herschbach, Peter; Dühmke, Eckhart

doi:10.1159/000069862

Cited by 39 publications

(43 citation statements)

References 19 publications

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“…Another study investigated the survival and QOL of patients who were randomized to WBRT with efaproxiral or to WBRT alone 70 . Six other studies examined the role of QOL or patient-rated symptoms when assessing the effectiveness of WBRT 17,[71][72][73][74][75] . Two studies assessed the neurocognitive function (NCF) of patients who had been treated with WBRT and a radiosensitizer 76 or with WBRT alone 27 .…”

Section: Multiple Brain Metastasesmentioning

confidence: 99%

“…Of the 8 QOL instruments used, 2 were study-designed assessments 68,74 . Kondziolka et al 68 designed a 10-item survey to ask patients treated with WBRT and radiosurgery or with radiosurgery alone about their treatment perceptions, side effects (hair loss, fatigue, memory, mood or affect, intellectual concentration, employment), activity level, and overall satisfaction.…”

Section: Qol Instrumentsmentioning

confidence: 99%

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Quality of Life in Brain Metastases Radiation Trials: A Literature Review

et al. 2008

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BackgroundAn estimated 20%-40% of cancer patients will develop brain metastases. Whole-brain radiotherapy (WBRT) is the standard treatment for patients with brain metastases. Although WBRT can reduce neurologic symptoms, the median survival following WBRT is between 3 and 6 months. Given this limited survival, it is important to consider quality of life (QOL) when treating patients with brain metastases. However, few studies have focused on QOL and improvement in patient-rated symptoms as primary outcomes. ObjectiveFor an accurate measurement of the extent to which previous trials have utilized QOL tools to evaluate the efficacy of WBRT for treatment of brain metastases, we undertook a literature review to examine the common endpoints and QOL instruments used. MethodsWe conducted a systematic search using the MEDLINE (1950( to December 2007 and Cochrane Central Register of Controlled Trials (4th quarter 2007) databases. Eligible studies investigated WBRT in one of the study arms. The following outcomes were included: median survival, overall survival, neurologic function, 1-year local control, and overall response; use of QOL instruments, performance status scales, and neurologic function assessments; and use of other assessment tools. Patient-rated QOL instruments were defined as those that strove to assess all dimensions of QOL; observerrated performance instruments such as the Karnofsky performance status (KPS) were deemed to be performance scales. ResultsWe identified sixty-one trials that included WBRT nine evaluated the treatment of a single brain metastasis, and fifty-two evaluated the treatment of multiple brain metastases. Although fifty-five of the trials employed a QOL instrument, few trials focused on QOL as an outcome. We found 23 different instruments used to evaluate QOL. The most commonly employed instrument was the KPS (n = 33), followed by various neurologic function classification scales (n = 21). A preponderance of the studies used 1 (n = 26, 43%) or 2 (n = 21, 34%) QOL instruments.A total of fourteen published trials on brain metastases included an evaluation of the study population's QOL. Those trials included three that used the Functional Assessment of Cancer Therapy-General scale and Brain subscale instrument, three that used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (C30) and the Brain Cancer Module 20 instrument, two that used study-designed QOL instruments, one that used the Edmonton Symptom Assessment Scale, two that used the Spitzer Quality of Life index, and three that used the KPS to evaluate QOL. Some trials reported deterioration in QOL after WBRT in patients with poorer prognosis; other trials detected an improvement in QOL after WBRT in patients with better prognosis. ConclusionsTo date, fourteen trials in brain metastases that have included an evaluation of the study population's QOL have been published. Although some studies showed that certain parameters of QOL deteriorate after WBRT, other studies showed that Q...

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Section: Multiple Brain Metastasesmentioning

confidence: 99%

Section: Qol Instrumentsmentioning

confidence: 99%

Quality of Life in Brain Metastases Radiation Trials: A Literature Review

et al. 2008

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“…Previous studies in brain tumour patients showed that HRQOL factors and/or cognitive functioning were statistically significant factors in prediction models for groups of patients, comparable to our classical analysis. For example, Sehlen et al (2003) examined HRQOL in 153 patients with either malignant astrocytoma or brain metastases. Using the Functional Assessment of Cancer Therapy General HRQOL measure (Cella et al, 1993), they found two variables, that is, 'living with a spouse' and the FACT-G total score to predict survival.…”

Section: Multivariate Analysismentioning

confidence: 99%

“…Only three studies have examined HRQOL and/or cognitive functioning as a prognostic factor in brain cancer (Meyers et al, 2000;Klein et al, 2003;Sehlen et al, 2003). The present study evaluates the prognostic value of HRQOL data collected from a prospective, large-scale international randomised controlled trial, by using various statistical techniques in an attempt to provide robust conclusions on the prognostic value of HRQOL in glioblastoma multiforme patients.…”

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confidence: 99%

The prognostic value of health-related quality-of-life data in predicting survival in glioblastoma cancer patients: results from an international randomised phase III EORTC Brain Tumour and Radiation Oncology Groups, and NCIC Clinical Trials Group study

et al. 2007

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This is one of the few studies that have explored the value of baseline symptoms and health-related quality of life (HRQOL) in predicting survival in brain cancer patients. Baseline HRQOL scores (from the EORTC QLQ-C30 and the Brain Cancer Module (BN 20)) were examined in 490 newly diagnosed glioblastoma cancer patients for the relationship with overall survival by using Cox proportional hazards regression models. Refined techniques as the bootstrap re-sampling procedure and the computation of C-indexes and R 2 -coefficients were used to try and validate the model. Classical analysis controlled for major clinical prognostic factors selected cognitive functioning (P ¼ 0.0001), global health status (P ¼ 0.0055) and social functioning (Po0.0001) as statistically significant prognostic factors of survival. However, several issues question the validity of these findings. C-indexes and R 2 -coefficients, which are measures of the predictive ability of the models, did not exhibit major improvements when adding selected or all HRQOL scores to clinical factors. While classical techniques lead to positive results, more refined analyses suggest that baseline HRQOL scores add relatively little to clinical factors to predict survival. These results may have implications for future use of HRQOL as a prognostic factor in cancer patients.

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“…In this context, health‐related quality of life (HRQoL) is a major subject of concern for patients with UGB, who are often symptomatic at the time of diagnosis and are confronted with cognitive deficit due to tumor burden 4, 5, 6, 7. In palliative care patients, the prognostic value of HRQoL has been demonstrated for several types of cancer 8.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of health‐related quality of life for death risk stratification in patients with unresectable glioblastoma

et al. 2016

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Glioblastoma is the most common malignant brain tumor in adults. Baseline health‐related quality of life (HRQoL) is a major subject of concern for these patients. We aimed to assess the independent prognostic value of HRQoL in unresectable glioblastoma (UGB) patients for death risk stratification. One hundred and thirty‐four patients with UGB were enrolled from the TEMAVIR trial. HRQoL was evaluated at baseline using the EORTC QLQ‐C30 and BN20 brain cancer module. Clinical and HRQoL parameters were evaluated in univariable and multivariable Cox analysis as prognostic factors for overall survival (OS). Performance assessment and internal validation of the final model were evaluated with Harrel's C‐index, calibration plot, and bootstrap sample procedure. Two OS independent predictors were identified: future uncertainty and sensitivity deficit. The final model exhibited good calibration and acceptable discrimination (C statistic = 0.63). The internal validity of the model was verified with robust uncertainties around the hazard ratio. The prognostic score identified three groups of patients with distinctly different risk profiles with median OS estimated at 16.2, 9.2, and 4.5 months. We demonstrated the additional prognostic value of HRQoL in UGB for death risk stratification and provided a score that may help to guide clinical management and stratification in future clinical trials.

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Quality of Life (QoL) as Predictive Mediator Variable for Survival in Patients with Intracerebral Neoplasma During Radiotherapy

Cited by 39 publications

References 19 publications

Quality of Life in Brain Metastases Radiation Trials: A Literature Review

Quality of Life in Brain Metastases Radiation Trials: A Literature Review

The prognostic value of health-related quality-of-life data in predicting survival in glioblastoma cancer patients: results from an international randomised phase III EORTC Brain Tumour and Radiation Oncology Groups, and NCIC Clinical Trials Group study

Prognostic value of health‐related quality of life for death risk stratification in patients with unresectable glioblastoma

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