Glioblastoma multiforme quality of life

Despite tumor surgery, radiotherapy, and temozolomide chemotherapy, the prognosis of glioblastoma multiforme is poor, with a median survival of 16 to 19 months and poor quality of life throughout the disease course 1) 2).

Relatives scored worse for mental HRQoL and emotional well-being than patients, suggesting that HRQoL in patients and relatives might be connected to symptoms of anxiety in the respective individual at disease onset. The results illustrate the need to screen HRQoL and emotional well-being in both patients and relatives from an early stage-before surgery 3).

The patients' inevitable loss of independence, which can occur suddenly or gradually, is tragic, and the eventual complete dependence can be overwhelming to the family and caregivers.

Patients and families need emotional and practical support throughout the continuum of this devastating disease. Astute neurologic assessment skills and immediate and appropriate interventions are required to maintain the patient's functional status 4).

Given the poor prognosis of GBM, the primary objectives of therapy are to reduce morbidity, restore or preserve neurologic functions and the capacity to perform daily activities as long as possible 5)

QoL and cognitive long-term assessments are feasible also in some patients with GB after a symptomatic progression. Our study demonstrates maintenance of QoL and cognitive summary scales before tumor progression. Moreover, it highlights subgroups according to tumor location and socioeconomic factors 6).

Thirty unselected patients ≥ 18 years who underwent primary surgery for glioblastoma in the period 2011-2013 were included. Using the generic HRQoL questionnaire EQ-5D 3L, baseline HRQoL was assessed before surgery and at postoperative follow-up after 1, 2, 4, 6, 8, 10, and 12 months.

There was an apparent correlation between deterioration in HRQoL scores and tumor progression. Patients with permanent deterioration in HRQoL early after surgery represented a subgroup with rapid progression and short survival. Both positive and negative changes in HRQoL were more often seen after surgery than after radio- or chemotherapy. Patients with gross total resection (GTR) reported better and more stable HRQoL. In a multivariable analysis preoperative cognitive symptoms (p = 0.02), preoperative functional status (p = 0.03), and GTR (p = 0.01) were independent predictors of quality of survival (area under the curve for EQ-5D 3L index values).

The results indicate that progression free survival is not only a surrogate marker for survival, but also for quality of survival. Quality of survival seems to be associated with GTR, which adds further support for opting for extensive resections in glioblastoma patients with good preoperative functional levels 7).

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Ståhl P, Fekete B, Henoch I, et al. Health-related quality of life and emotional well-being in patients with glioblastoma and their relatives [published online ahead of print, 2020 Sep 9]. J Neurooncol. 2020;10.1007/s11060-020-03614-5. doi:10.1007/s11060-020-03614-5
Davis ME, Stoiber AM. Glioblastoma multiforme: enhancing survival and quality of life. Clin J Oncol Nurs. 2011 Jun;15(3):291-7. doi: 10.1188/11.CJON.291-297. Review. PubMed PMID: 21624864.
Macdonald DR, Kiebert G, Prados M, Yung A, Olson J. Benefit of temozolomide compared to procarbazine in treatment of glioblastoma multiforme at first relapse: effect on neurological functioning, performance status, and health related quality of life. Cancer Invest. 2005;23(2):138-44. Review. PubMed PMID: 15813507.
Flechl B, Sax C, Ackerl M, Crevenna R, Woehrer A, Hainfellner J, Preusser M, Widhalm G, Kiesel B, Lütgendorf-Caucig C, Dieckmann K, Steffal C, Marosi C, Hassler MR. The course of quality of life and neurocognition in newly diagnosed patients with glioblastoma. Radiother Oncol. 2017 Aug 8. pii: S0167-8140(17)32486-6. doi: 10.1016/j.radonc.2017.07.027. [Epub ahead of print] PubMed PMID: 28801008.
Sagberg LM, Solheim O, Jakola AS. Quality of survival the 1st year with glioblastoma: a longitudinal study of patient-reported quality of life. J Neurosurg. 2015 Oct 2:1-9. [Epub ahead of print] PubMed PMID: 26430849.
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