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Predictors of health-related quality of life in neurosurgical brain tumor patients: Focus on patient-centered perspective
Abstract
In brain tumor (BT) patients, the association between health-related quality of life (HRQoL) and psychological characteristics remains largely unknown. We evaluated the association of personality traits, clinical factors, psychological distress symptoms, and cognitive state with HRQoL in BT patients.
On admission for BT surgery, 200 patients (69 % women; age 55.8 ± 14.5 years) were evaluated for HRQoL (SF-36 scale), Big-Five personality traits (Ten-Item Personality Inventory), psychological distress symptoms (Hospital Anxiety and Depression Scale or HADS), cognitive function (Mini-Mental State Examination or MMSE) and clinical characteristics, including functional status (Barthel index or BI). The most common BT diagnoses were meningioma (39 %) and high-grade glioma (18 %).
Only factors significantly associated with SF-36 domains in univariable regression analyses were included in their respective multivariable models and predicted from 6 %-49 % of the total variance of SF-36 scores. Greater TIPI emotional stability score was independently associated with greater SF-36 emotional well-being (β = 0.23, p < 0.001) and general health (β = 0.18, p = 0.01) scores, and greater TIPI consciousness score, with greater SF-36 emotional well-being score (β = 0.13, p = 0.02). HADS-anxiety and HADS-depression scores were the strongest independent determinants of all, except physical functioning, SF-36 scores (β-values range from 0.14 to 0.56; p values ≤ 0.03). BI score was the strongest independent determinant of SF-36 physical functioning score (β = 0.36, p < 0.001). MMSE score was associated with all but emotional well-being and social functioning SF-36 scores.
Consciousness and emotional stability should be considered important personality-related determinants of HRQoL in BT patients. Psychological distress, functional disability, and cognitive impairment are also important predictors of HRQoL.
... One important aspect of quality of life that is largely studied among cancer outcomes is mental health [8]. Previous studies have concluded that there are significant associations between mental health disorders (MHDs) and the etiologies and prognoses of various subtypes of cancer [9]. ...
... Broadly, lifestyle detriments associated with LGG disease progression may have profound impacts on MHD onset and QoL [8,37]. Given the frequent location of LGG tumors in eloquent brain areas, patients may suffer from dysfunction in speech, motor skills, ambulation, vision, and cognition, among many other things, and these deficits can present even during stable disease periods [37]. ...
Simple Summary
Low-grade gliomas (LGGs) comprise 13–16% of glial tumors. As survival for LGG patients has been improving, it is important to consider the effects of diagnosis and treatment on mental health. The aims of this retrospective cohort study were to determine the incidence, prevalence, and risk factors of mental health disorders (MHD) in LGG patients. In our analysis including 20,432 LGG patients, we identified an MHD prevalence of 60.9%. Of those with no history of prior MHD, 16.9% of LGG patients developed a new onset of MHD within 12 months of LGG diagnosis. Risk factors included female gender, ages 35–54, presence of seizures, and first-line surgical treatment. Therefore, proactive surveillance and counseling surrounding MHDs are recommended among LGG patients. Impact of surgery on brain networks affecting mood should also be considered.
Abstract
Low-grade gliomas (LGGs) comprise 13–16% of glial tumors. As survival for LGG patients has been gradually improving, it is essential that the effects of diagnosis and disease progression on mental health be considered. This retrospective cohort study queried the IBM Watson Health MarketScan® Database to describe the incidence and prevalence of mental health disorders (MHDs) among LGG patients and identify associated risk factors. Among the 20,432 LGG patients identified, 12,436 (60.9%) had at least one MHD. Of those who never had a prior MHD, as documented in the claims record, 1915 (16.7%) had their first, newly diagnosed MHD within 12 months after LGG diagnosis. Patients who were female (odds ratio (OR), 1.14, 95% confidence intervals (CI), 1.03–1.26), aged 35–44 (OR, 1.20, 95% CI, 1.03–1.39), and experienced glioma-related seizures (OR, 2.19, 95% CI, 1.95–2.47) were significantly associated with MHD incidence. Patients who underwent resection (OR, 2.58, 95% CI, 2.19–3.04) or biopsy (OR, 2.17, 95% CI, 1.68–2.79) were also more likely to develop a MHD compared to patients who did not undergo a first-line surgical treatment. These data support the need for active surveillance, proactive counseling, and management of MHDs in patients with LGG. Impact of surgery on brain networks affecting mood should also be considered.
... When it comes to psychiatric presentation, first, it is important to note that the degree of change in one's happiness (level of anxiety, depression, and happiness) around a "set point" would be influenced by the individual's capacity to adjust to their new medical condition. Elevated scores in emotional stability and awareness represent psychological factors linked to improved HRQoL, whereas cognitive dysfunction and diminished functionality contribute to a decline in HRQoL [25]. ...
Meningiomas are common benign brain tumors that may significantly impact patients’ Health-Related Quality of Life (HRQOL) and functional disability. The assessment of HRQOL in meningioma patients is heterogeneous, necessitating standardized approaches. Patient-Reported Outcome Measures (PROMs) are increasingly used to capture patients’ perspectives, with various questionnaires developed for this purpose. Medical and non-medical risk factors for long-term HRQOL impairment encompass tumor characteristics, treatment factors, and sociodemographic features. Symptomatic meningioma patients experience lower HRQOL scores, with symptoms influenced by tumor features such as location, edema, and size. Prominent subsequent manifestations, including epilepsy, neurocognitive dysfunction, and psychiatric symptoms, significantly influence HRQOL. Surgical resection is the primary therapeutic option, and adjuvant radiotherapy may be considered for recurrent or high-risk cases. Although patients generally experience improved HRQOL post-surgery, some may face long-term declines, necessitating comprehensive long-term well-being evaluation. Patients often undergo positive changes in mental outlook (posttraumatic growth), triggering a “response shift” that may alter patients’ values and internal standards, ultimately improving their perception of HRQOL. Long-term outcomes highlight meningioma’s chronic impact on patients’ lives and socioeconomic burden. Overall, understanding and addressing these factors optimizes patients’ well-being and functional outcomes. A holistic approach considering medical and psychosocial aspects is crucial for enhancing HRQOL in meningioma patients.
... By analyzing the controversies regarding the Superior Longitudinal System's subdivisions and the respective nomenclatures, our recent literature review (Vavassori et al., 2021) already exposed the current knowledge about the structural wiring of the AF intended as a whole ensemble of fibers connecting the frontal and the temporal lobes of the same hemisphere by passing above the insula (Mandonnet et al., 2018). (Bunevicius et al., 2014;Hervey-Jumper & Berger, 2016;Sanai et al., 2011;Zarino et al., 2020;Zigiotto et al., 2020). With this aim, we append to our literature review a description of surgical approaches to tumor resection that require the careful consideration of this bundle extension, its relationships with the nearby anatomical structures and the related functional implications, and provide a collection of four different surgical cases to highlight how, in practice, extensive knowledge of the AF features can be applied in this field. ...
Background
Two Centuries from today, Karl Friedrich Burdach attributed the nomenclature “arcuate fasciculus” to a white matter (WM) pathway connecting the frontal to the temporal cortices by arching around the Sylvian fissure. Although this label remained essentially unvaried, the concepts related to it and the characterization of the structural properties of this bundle evolved along with the methodological progress of the past years. Concurrently, the functional relevance of the arcuate fasciculus (AF) classically restricted to the linguistic domain has extended to further cognitive abilities. These features make it a relevant structure to consider in a large variety of neurosurgical procedures.
Objective
Herein, we build on our previous review uncovering the connectivity provided by the Superior Longitudinal System, including the AF, and provide a handy representation of the structural organization of the AF by considering the frequency of defined reports in the literature. By adopting the same approach, we implement an account of which functions are mediated by this WM bundle. We highlight how this information can be transferred to the neurosurgical field by presenting four surgical cases of glioma resection requiring the evaluation of the relationship between the AF and the nearby structures, and the safest approaches to adopt.
Conclusions
Our cumulative overview reports the most common wiring patterns and functional implications to be expected when approaching the study of the AF, while still considering seldom descriptions as an account of interindividual variability. Given its extension and the variety of cortical territories it reaches, the AF is a pivotal structure for different cognitive functions, and thorough understanding of its structural wiring and the functions it mediates is necessary for preserving the patient's cognitive abilities during glioma resection.
... Glioblastoma, the most aggressive primary brain cancer, has a median overall survival of less than two years [1,2] and is associated with a considerable burden of cognitive deficits [3][4][5][6][7][8] due to both the diffuse nature of the disease [9] and the aggressive nature of treatment with maximal surgical resection [10] and radical radiotherapy regimens [11]. Cognitive function has been associated with poor health-related quality of life and the subject of patient-reported outcome literature, in particular a comprehensive survey of 1004 patients by the Brain Tumour Charity that described what life is really like for adults living with a brain tumour [12][13][14][15][16]. ...
Glioblastoma and the surgery to remove it pose high risks to the cognitive function of patients. Little reliable data exist about these risks, especially postoperatively before radiotherapy. We hypothesized that cognitive deficit risks detected before surgery will be exacerbated by surgery in patients with glioblastoma undergoing maximal treatment regimens. We used longitudinal electronic cognitive testing perioperatively to perform a prospective, longitudinal, observational study of 49 participants with glioblastoma undergoing surgery. Before surgery (A1), the participant risk of deficit in 5/6 cognitive domains was increased compared to normative data. Of these, the risks to Attention (OR = 31.19), Memory (OR = 97.38), and Perception (OR = 213.75) were markedly increased. These risks significantly increased in the early period after surgery (A2) when patients were discharged home or seen in the clinic to discuss histology results. For participants tested at 4–6 weeks after surgery (A3) before starting radiotherapy, there was evidence of risk reduction towards A1. The observed risks of cognitive deficit were independent of patient-specific, tumour-specific, and surgery-specific co-variates. These results reveal a timeframe of natural recovery in the first 4–6 weeks after surgery based on personalized deficit profiles for each participant. Future research in this period could investigate personalized rehabilitation tools to aid the recovery process found.
... The HADS has high validity 35 and has specifically been used to assess depression and anxiety symptoms of patients with other neurosurgical conditions including brain tumours. 36,37 Patients were categorized as: "anxious" and "depressed," according to a clinically significant HADS threshold of 8 on each subscale. 35,38 An ADL instrument adapted from existing scales 39 was developed after consultation between A.S.P., B.J., and A.K.T and a focus group of UIA patients to assess functional independence following, and because of, the patient's diagnosis. ...
BACKGROUND
Following a diagnosis of a small unruptured intracranial aneurysm (sUIA), patients often experience psychological ailments which may be attributable to the neurovascular consultation, referral pathway, or long‐term imaging surveillance. Here, we aim to characterize the early sUIA patient journey and evaluate their psychosocial status.
METHODS
A mixed‐methods analysis of sUIA patients attending a large tertiary neurosciences center was performed. For patients presenting to the neurovascular service in 2020, this included: (i) a thematic analysis of patient perspectives extracted from semistructured telephone interviews, (ii) a quantitative assessment of psychological status using the Hospital Anxiety and Depression Scale and (iii) an evaluation of functional independence using a customized activity of daily living questionnaire. The relationship between service or clinical factors, and Hospital Anxiety and Depression Scale subscale scores was statistically tested.
RESULTS
The sUIA patient cohort (n=105) had a mean age of 56.8 years (SD=15.8, female=69). Thematic analysis of interview responses (n=33) identified 5 recurrent themes underpinning the sUIA patient experience: referral, diagnosis and information sharing, imaging surveillance, psychological impairment and coping strategies, and activities of daily living, all of which contributed to patient concerns. A total of 53.6% of patients achieved a Hospital Anxiety and Depression Scale score signifying at least mild anxiety and/or depression. Lifestyle changes most frequently affected after diagnosis included avoidance of straining‐intensive exercise, change in patterns of substance use, and work‐related performance. Multivariate analysis revealed no significant service or clinical predictors for anxiety or depression.
CONCLUSION
For some patients, an sUIA diagnosis appears to be associated, at least qualitatively, with a psychological burden. This is likely mediated through stressors related to the referral, diagnosis, neurosurgical consultation, and image surveillance. In the absence of evidence‐based guidelines regarding these aspects of the early patient journey, we offer suggestions aimed at improving both the neurovascular service and sUIA patient experience.
... For mental well-being, subscales of general HRQoL such as emotional well-being were included, as were anxiety and depression questionnaires as they are inversely correlated with (HR)QoL. 21 If a study included multiple questionnaires to assess the same outcome measure, we included the generic rather than the disease-specific questionnaire. If still multiple questionnaires could be included, we selected the questionnaire with the highest validity. ...
Background
Cannabinoids have been suggested to alleviate frequently experienced symptoms of reduced mental well-being such as anxiety and depression. Mental well-being is an important subdomain of health-related quality of life (HRQoL). Reducing symptoms and maintaining HRQoL are particularly important in malignant primary brain tumor patients, as treatment options are often noncurative and prognosis remains poor. These patients frequently report unprescribed cannabinoid use, presumably for symptom relieve. As studies on brain tumor patients specifically are lacking, we performed a meta-analysis of the current evidence on cannabinoid efficacy on HRQoL and mental well-being in oncological and neurological patients.
Methods
We performed a systematic PubMed, PsychINFO, Embase, and Web of Science search according to PRISMA guidelines on August 2 and 3, 2021. We included randomized controlled trials (RCTs) that assessed the effects of tetrahydrocannabinol (THC) or cannabidiol (CBD) on general HRQoL and mental well-being. Pooled effect sizes were calculated using Hedges g. Risk of bias of included studies was assessed using Cochrane's Risk of Bias tool.
Results
We included 17 studies: 4 in oncology and 13 in central nervous system (CNS) disease. Meta-analysis showed no effect of cannabinoids on general HRQoL (g=−0.02 confidence interval [95% CI −0.11 to 0.06]; p=0.57) or mental well-being (g=−0.02 [95% CI −0.16 to 0.13]; p=0.81).
Conclusions
RCTs in patients with cancer or CNS disease showed no effect of cannabinoids on HRQoL or mental well-being. However, studies were clinically heterogeneous and since many glioma patients currently frequently use cannabinoids, future studies are necessary to evaluate its value in this specific population.
... HRQoL of patients, presented as PCS and MCS in SF-36, compared with an age-and gender-matched control group, showed that the patients had lower PCS and MCS than the general population at all time points measured. In addition, the patients' mental HRQoL was affected in connection with oncological treatment, which has been described previously,7,27,28 although to date there has been only limited data regarding long-term follow-up. It is alarming that patients with glioblastoma rate HRQoL worse than a matched control group and also have worse HRQoL than patients with other types of malignancies such as breast cancer and lung cancer.7 ...
Objectives:
Glioblastoma is the most aggressive primary brain tumour in adults. The rapid decline of physical and cognitive functions is likely to affect patients and relatives during the entire course of disease. The aim of this study was to describe and compare (a) health-related quality of life (HRQoL) and psychological symptoms between patients with glioblastoma and their relatives, and (b) HRQoL between patients and a general population over time.
Methods:
At baseline, 63 patients and 63 relatives were included. The participants completed the Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression scale (HADS) at seven different occasions from pre-surgery until two years post-surgery. A comparison of SF-36 was made between patients and an age- and gender-matched control group. Descriptive analysis, effect size and Wilcoxon signed-rank test were used.
Results:
Relatives scored lower health-related quality of life (HRQoL) and higher symptoms of anxiety than patients, whilst patients scored worse in the physical parts of the SF-36. Three weeks post-surgery, relatives scored their lowest HRQoL and had the highest risk of anxiety symptoms. Comparing patients with controls, the patients rated worse in both the mental and physical component summaries in HRQoL at most time points.
Conclusion:
Both patients and relatives showed deterioration of HRQoL. In addition, relatives showed high frequency of anxiety symptoms. Our data reveal that relatives of patients with glioblastoma need attention throughout the disease trajectory and they also need support at the right time point.
Objective
The purpose of this study was to explore the prevalence, severity, and factors associated with multidimensional fatigue in Chinese patients with newly diagnosed meningiomas.
Methods
This cross-sectional study included 120 Chinese meningioma patients. Data were collected before surgery, including demographic, clinical, psychological, and sleep characteristics, as well as fatigue scores based on completion of the Multidimensional Fatigue Inventory (MFI-20). Mann–Whitney U tests, Kruskal–Wallis H tests, Spearman correlation and multiple linear regression were used to analyze the data.
Results
The results showed there was a high prevalence of severe fatigue for each dimension: general fatigue (33.3%), physical fatigue (27.5%), reduced activity (28.3%), reduced motivation (12.5%), mental fatigue (11.7%), and total fatigue (23.3%). Headache and anxiety were found to be associated with general fatigue. Depression was related with physical fatigue. The Karnofsky Performance Status (KPS) score and depression were associated with reduced activity. Depression and the Epworth Sleepiness Scale (ESS) score were correlated with reduced motivation, while the KPS score and anxiety were associated with mental fatigue. Importantly, comorbidity, the KPS score, headache, depression, sleep disturbances, and the ESS score remained strong correlates of total fatigue.
Conclusions
Our findings indicate that newly diagnosed meningioma patients are affected by multidimensional fatigue. For patients with risk factors of fatigue, targeted interventions are advised to decrease fatigue and improve HRQoL.
Providing care to patients with cancer is complex and requires a multidisciplinary team to recognize and monitor the dynamic interplay between the psychological and behavioral manifestations that may occur throughout the cancer trajectory. Psychosocial issues range in severity and duration, and they may occur at any time after diagnosis through treatment and recovery. The consequences of many psychosocial issues can be distressing and result in life-long disability.
Objective:
Neuropsychiatric disorders in brain tumor patients are commonly observed. It is difficult to anticipate these disorders in different types of brain tumors. The goal of the study was to see how well machine learning (ML)-based decision algorithms might predict neuropsychiatric problems in different types of brain tumors.
Methods:
145 histopathologically-confirmed primary brain tumors of both gender aged 25-65 years of age, were included for neuropsychiatric assessments. The datasets of brain tumor patients were employed for building the models. Four different decision ML classification trees/models (J48, Random Forest, Random Tree & Hoeffding Tree) with supervised learning were trained, tested, and validated on class labeled data of brain tumor patients. The models were compared in order to determine the best accurate classifier in predicting neuropsychiatric problems in various brain tumors. Following categorical attributes as independent variables (predictors) were included from the data of brain tumor patients: age, gender, depression, dementia, and brain tumor types. With the machine learning decision tree/model techniques, a multi-target classification was performed with classes of neuropsychiatric diseases that were predicted from the selected attributes.
Results:
86 percent of patients were depressed, and 55 percent were suffering from dementia. Anger was the most often reported neuropsychiatric condition in brain tumor patients (92.41%), followed by sleep disorders (83%), apathy (80%), and mood swings (76.55%). When compared to other tumor types, glioblastoma patients had a higher rate of depression (20%) and dementia (20.25%). The developed models Random Forest and Random Tree were found successful with an accuracy up to 94% (10-folds) for the prediction of neuropsychiatric disorders in brain tumor patients. The multiclass target (neuropsychiatric ailments) accuracies were having good measures of precision (0.9-1.0), recall (0.9-1.0), F-measure (0.9-1.0), and ROC area (0.9-1.0) in decision models.
Conclusion:
Random Forest Trees can be used to accurately predict neuropsychiatric illnesses. Based on the model output, the ML-decision trees will aid the physician in pre-diagnosing the mental issue and deciding on the best therapeutic approach to avoid subsequent neuropsychiatric issues in brain tumor patients.
We conducted a population-based prospective cohort study in Denmark to investigate associations between the personality traits and cancer survival. Between 1976 and 1977, 1020 residents of the Copenhagen County completed a questionnaire eliciting information on personality traits and various health habits. The personality traits extraversion and neuroticism were measured using the short form of the Eysenck Personality Inventory. Follow-up in the Danish Cancer Registry for 1976-2002 revealed 189 incidents of primary cancer and follow-up for death from the date of the cancer diagnosis until 2005 revealed 82 deaths from all-cause in this group. A Cox proportional-hazards model was used to estimate the hazard ratios (HRs) of death from all-cause according to extraversion and neuroticism adjusting for potential confounding factors. A significant association was found between neuroticism and risk of death (HR, 2.3 (95% CI=1.1-4.7); Linear trend P=0.04) but not between extraversion and risk of death (HR, 0.9 (0.4-1.7); Linear trend P=0.34). Similar results were found when using cancer-related death. Stratification by gender revealed a strong positive association between neuroticism and the risk of death among women (Linear trend P=0.03). This study showed that neuroticism is negatively [corrected] associated with cancer survival. Further research on neuroticism and cancer survival is needed.
As an oncologist, when I sit with patients to discuss starting a new chemotherapy regimen, their first questions are often "How will it make me feel?" and "How did patients like me feel with this treatment?" Regrettably, this information is generally missing from U.S. drug labels and from published reports of clinical trials - the two information sources most commonly available to people trying to understand the clinical effects of cancer drugs. In 2011, 15 hematology-oncology drugs were approved by the U.S. Food and Drug Administration (FDA). In only one case - that of ruxolitinib for the management of myelofibrosis . . .
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
Object:
A low triiodothyronine (T3) state is highly prevalent and is associated with a poor prognosis in critically ill patients. The authors investigated, in patients undergoing brain tumor surgery, the direct association of a perioperative low T3 syndrome with clinical outcomes and also with symptoms of depression and anxiety.
Methods:
Ninety consecutive patients (71% women, median age 55 years), on admission for brain tumor surgery, were evaluated for sociodemographic and clinical characteristics. Their thyroid function profile was assessed on the morning of brain tumor surgery and on the morning after brain tumor surgery. Patients with free T3 concentrations of 3.1 pmol/L or less were considered to have low T3 syndrome. The patients were evaluated for symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) before and after surgery and for clinical outcomes using the Glasgow Outcome Scale (GOS) at discharge.
Results:
After brain tumor surgery, free T3 concentrations decreased (p < 0.001) and the proportion of patients with low T3 levels increased from 38% to 54% (p = 0.02). Lower preoperative (rho = 0.30, p = 0.004) and postoperative (rho = 0.33, p = 0.002) free T3 concentrations correlated with low GOS scores at discharge. Preoperative low T3 syndrome (OR 5.49, 95% CI 1.27-23.69, p = 0.02) and postoperative low T3 syndrome (OR 8.73, 95% CI 1.49-51.21, p = 0.02) both increased risk for unfavorable clinical outcomes (GOS scores < 5) at discharge, after adjusting for age, sex, histological diagnosis of brain tumor, preoperative functional impairment, previous treatment for brain tumor, and depressive symptoms. Preoperative low T3 syndrome increased the risk for preoperative (HADS-depression subscale score ≥ 11; OR 4.12, 95% CI 1.16-14.58, p = 0.03) but not postoperative depressive symptoms independently from sociodemographic and clinical factors.
Conclusions:
Low T3 syndrome is a strong independent predictor of unfavorable clinical outcomes and depressive symptoms, and its diagnosis and preoperative management should be considered in patients undergoing neurosurgery for the treatment of brain tumors.