Quality of life self-reports from 200 brain tumor patients: comparisons with Karnofsky performance scores

Abstract

To test a method of assessing quality of life, 200 primary brain tumor patients in an outpatient clinic answered a 20-minute questionnaire covering ten aspects of quality of life. These results were compared with Karnofsky performance scale (KPS) scores, taking age into account. Among patients with KPS 90-100 (two-thirds of the patients), the KPS alone was difficult to interpret. The questionnaire, with its specific questions related to the key dimension of well-being, provided a more definitive assessment of status. The central importance of well-being was supported by its strong statistical relationships with other dimensions. Particularly, well-being was related to freedom from depression (p < 0.0001), active social life (p < 0.0001), energy (p < 0.01), and fewer symptoms (p < 0.05). The KPS was more useful in differentiating the other one-third of the patients (KPS 50-80) but was highly sensitive to age. KPS scores, therefore, may have been unreliable. Depression, reported by half of the patients, was not predicted by the KPS when age was excluded from the regression analysis but was related to the scores in well-being and socializing. Neither depression, well-being, nor socializing was influenced by age. Thus, the questionnaire directly assessed these central, emotionally based variables, particularly among patients with satisfactory KPS. Such an assessment is especially crucial as a supplement to the KPS in evaluating brain tumor survivors, whose emotional well-being is often severely challenged by treatment after surgical excision.

Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy

“…KPS is an easy to assess and a reliable measure of functional status in cancer patients (16); however, it does not assess patients' difficulties with performing everyday activities when living at home. Furthermore, older patients tend to have lower KPS scores (14). In the present Table III.…”

“…A reduction in KPS scores was associated with recurrence in the outpatients. In previous studies, KPS scores have been generally correlated with overall QOL in patients with brain tumors (11,(13)(14)(15). KPS is an easy to assess and a reliable measure of functional status in cancer patients (16); however, it does not assess patients' difficulties with performing everyday activities when living at home.…”

Review on Quality of Life Issues in Patients with Primary Brain Tumors

“…HRQOL studies of LGG patients have employed small samples with a mix of tumor grades, or have employed study-specific HRQOL measures that render comparison of results across studies difficult [25,26]. Despite these methodological limitations, the studies conducted to date suggest that many survivors of LGG suffer from cognitive deficits, assessed both objectively and subjectively, and compromised HRQOL, for example, increased fatigue or depression [27][28][29][30][31].…”

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

“…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.…”

“…[26] The main criticism of the KPS is its lack of sensitivity in patients with brain tumors who are relatively well (KPS > 80); this is a "ceiling" effect. [19,25,36,60] These functionally independent patients may show subtle cognitive deficits and other QOL dimensions because of tumor location and the effects of therapy. These deficits can only be detected with QOL measures that more specifically evaluate these functions in brain tumor patients.…”