vestibular_schwannoma_quality_of_life

2015

There was a total sample population of 376 patients diagnosed with a unilateral VS. INTERVENTION: A total of 223 patients with unilateral VS returned the mailed questionnaires. These were then divided into two groups-78 that had undergone microsurgical excision and 145 that were managed conservatively. Subgroups within these primary groups were created for analysis. MAIN OUTCOME MEASURE: The primary outcome measure was the Medical Outcomes Study 36 Items Short Form (SF-36). The Dizziness Handicap Inventory test, Hearing Handicap Inventory test, and Tinnitus Handicap Inventory were also used. RESULTS: The surgically managed group had a worse QOL when compared with the conservatively managed group using SF-36, significantly so in the domains of physical role limitation and social functioning. Trends were seen toward a better QOL in some domains in the subgroups of male patients and patients younger than 65 years. Worse QOL scores in the Tinnitus Handicap Inventory were seen in the subgroups with larger tumor size. Finally, on correlation analysis between all handicap inventories and SF-36, handicap due to disequilibrium had the strongest correlation with worsening of QOL. In SF-36, the vitality domain showed the greatest correlation with otologic handicap overall, whereas the role emotional domain showed the least. CONCLUSION: This study found that worse QOL scores for surgically managed versus conservatively managed VS patients are most significant in the areas of physical role limitation and social functioning. In some areas, patients who are male and younger report better QOL. Handicap due to disequilibrium seems to have the greatest negative impact on QOL. These factors should be considered when counseling patients regarding approach to VS, in the context of an experienced management program 1).


Very few publications have investigated health related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument.

All patients with sporadic small- to medium-sized vestibular schwannomas (VSs) who underwent primary vestibular schwannoma surgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison.

A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures.

The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not confer a long-term HRQOL advantage, small- and medium-sized VS should be initially observed, while intervention should be reserved for patients with unequivocal tumor growth or intractable symptoms that are amenable to treatment. Future studies assessing HRQOL in VS patients should prioritize use of validated disease-specific measures, such as the PANQOL, given the significant limitations of generic instruments in distinguishing between treatment groups and tumor versus non tumor subjects 2)

2014

Ongoing dizziness and headache are the strongest predictors of long-term quality of life reduction in patients with sporadic vestibular schwannoma (VS), while the impact of hearing loss, facial nerve function, and tinnitus are less by comparison. This information may be valuable for patient counseling, refinement of VS quality-of-life assessment instruments, and determining high-yield targets for therapy in efforts to further improve patient outcomes 3).


Patients harboring large or giant VSs score lower on all the QOL domains compared with the normative population. More than 60% showed a clinically significant improvement in HR-QOL 1 year after surgery, a result that was sustained at subsequent follow-up 4).


Vertigo and postoperative hearing status could be identified as the parameters with the strongest influence on QOL 5).


1)
Jufas N, Flanagan S, Biggs N, Chang P, Fagan P. Quality of Life in Vestibular Schwannoma Patients Managed by Surgical or Conservative Approaches. Otol Neurotol. 2015 Jun 12. [Epub ahead of print] PubMed PMID: 26075673.
2)
Carlson ML, Tveiten OV, Driscoll CL, Goplen FK, Neff BA, Pollock BE, Tombers NM, Castner ML, Finnkirk MK, Myrseth E, Pedersen P, Lund-Johansen M, Link MJ. Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg. 2015 Jan 2:1-10. [Epub ahead of print] PubMed PMID: 25555165.
3)
Carlson ML, Tveiten ØV, Driscoll CL, Goplen FK, Neff BA, Pollock BE, Tombers NM, Lund-Johansen M, Link MJ. What drives quality of life in patients with sporadic vestibular schwannoma? Laryngoscope. 2014 Dec 27. doi: 10.1002/lary.25110. [Epub ahead of print] PubMed PMID: 25546382.
4)
Turel MK, Thakar S, Rajshekhar V. Quality of life following surgery for large and giant vestibular schwannomas: a prospective study. J Neurosurg. 2014 Dec 5:1-9. [Epub ahead of print] PubMed PMID: 25479119.
5)
Scheich M, Ginzkey C, Reuter E, Harnisch W, Ehrmann D, Hagen R. Quality of life after microsurgery for vestibular schwannoma via the middle cranial fossa approach. Eur Arch Otorhinolaryngol. 2014 Jul;271(7):1909-16. doi: 10.1007/s00405-013-2671-1. Epub 2013 Sep 6. PubMed PMID: 24061568.
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