Changing practice to improve quality of life in glioma

Catherine E. Wassef Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York;

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Sarah A. Cain Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; and

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Katharine J. Drummond Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; and
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia

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As treatment for glioma advances, with an attendant improvement in length of patient survival, the quality of that survival has rightly become an increasingly important patient-centered metric, and health-related quality of life (HRQOL) an important outcome measure. HRQOL is a self-assessed, multidimensional concept encompassing the physical, emotional, and social components of quality of life associated with illness and its treatment. Neurosurgeons caring for patients with gliomas should be aware of the latest research on HRQOL to understand mechanisms by which it can be improved. Neurosurgical outcomes related to surgical complications and neurological deficits can be important determinants of HRQOL and are well understood by neurosurgeons. However, an understanding of more general or global determinants of HRQOL not commonly addressed in the clinic, and implementation of the attendant evidence-based interventions to address them, would be transformative. The authors explore HRQOL determinants related to patient-, social-, tumor-, and treatment-related factors, with a particular emphasis on the strongest determinants, fatigue, sleep disturbance, anxiety, depression, neurocognitive dysfunction, caregiver distress, and end-of-life concerns. Evidence-based interventions are reviewed, including fatigue management, cognitive rehabilitation, insomnia interventions exercise, caregiver training, palliative care, and an overall multidisciplinary team approach. Lastly, features of a program are outlined that would embed HRQOL in neurosurgical care to the benefit of both patients and staff.

ABBREVIATIONS

AED = antiepileptic drug; CBT = cognitive behavioral therapy; EORTC = European Organisation for Research and Treatment of Cancer; EORTC QLQ-BN20 = EORTC Quality of Life Questionnaire–Brain Tumor Module; EORTC QLQ-C30 = EORTC Quality of Life Questionnaire–General Cancer Module; EQ-5D = EuroQoL 5D; ERAS = enhanced recovery after surgery; FACIT = Functional Assessment of Chronic Illness Therapy; FACT = Functional Assessment of Cancer Therapy; FACT-Br = FACT–Brain Questionnaire; FACT-G = FACT–General Cancer Questionnaire; HGG = high-grade glioma; HRQOL = health-related quality of life; LGG = low-grade glioma; MDASI = MD Anderson Cancer Center Symptom Inventory; MDASI-BT = MDASI–Brain Tumor Module; MOS SF-36 = Medical Outcomes Study Short Form-36; NCCN = National Comprehensive Cancer Network; RCT = randomized controlled trial; SES = socioeconomic status.
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    McAlpine H, Joubert L, Martin-Sanchez F, Merolli M, Drummond KJ. A systematic review of types and efficacy of online interventions for cancer patients. Patient Educ Couns. 2015;98(3):283295.

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