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Some long-term survivors of low-grade glioma experience decline in health-related quality of life
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Some long-term survivors of low-grade glioma may experience a significant decline in physical role function and general health perceptions despite having stable disease, according to study results.
Although low-grade gliomas may eventually evolve into more aggressive tumors, they usually have a favorable prognosis and an extensive period of stable disease, according to study background. Still, results from studies have indicated patients with low-grade gliomas experience a poorer quality of life than healthy controls and even patients with high-grade gliomas.
Florien W. Boele, MSc, a PhD candidate at VU University Medical Center in Amsterdam, and colleagues conducted this study to examine changes in health-related quality of life in a cohort of 195 patients with grade I or grade II glioma who had been clinically stable for an average of 12 years. Researchers compared these results with data from individually matched healthy controls.
The patients had participated in previous multicenter studies on health-related quality of life and cognitive functioning with assessments at midterm (mean, 6 years) and long-term (mean, 12 years) follow-up. Using the Dutch version of the 36-item short-form health survey (SF-36), patients self-assessed their quality of life on 36 items in eight categories related to physical and emotional function, mental health and other general health perceptions.
Of the 195 patients who participated in the study, 67 (mean age, 44.5 years) were able to complete the long-term follow-up assessment. Thirty percent of the original cohort was deceased, 23% had tumor recurrence or treatment, 3% declined participation and 10% could not be traced or had other reasons to no longer participate. Two additional patients were excluded for incomplete data (final population, n = 65).
Although there was no statistically significant difference between the patients with low-grade glioma and the healthy controls at the midterm follow-up, there was a significant decline in physical role functioning (P = .004) and general health perceptions (P = .004) among the glioma group at long-term follow-up.
Among patients with stable low-grade glioma, physical health-related quality of life — assessed using the SF-36 physical component summary and physical functioning subscale — was significantly worse at long-term follow-up than at midterm follow-up (P < .001 for both).
Overall, whereas 48% of patients remained stable or improved on all health-related quality of life scales, 38.5% of the cohort experienced a noticeable decline in at least one scale.
The researchers identified some limitations with their study, including that the analyses did not reflect meaningful changes in quality of life determined by the patients themselves. Any future, similar studies should incorporate a patient-reported anchor to assess any change that could be deemed significant, researchers wrote.
A second issue was that the measurements were not based on a fixed interval after diagnosis, leading to a wide variety in disease duration at the time of each assessment.
“Health-related quality of life remained mostly preserved in patients with long-term, stable low-grade glioma, whereas subtle decline was observed in physical functioning on the group level,” the researchers wrote. “Although our outcomes are reassuring, we also found that 38.5% of patients experienced detectable decline in specific aspects of health-related quality of life.
“Future studies into meaningful change, as well as the associations of patient, disease or treatment-related variables with decline in health-related quality of life, are recommended to better aid patients with low-grade glioma in dealing with the possible mental and physical consequences of low-grade glioma,” they wrote. – by Anthony SanFilippo
Disclosure: The researchers report honoraria from, consultant/advisory roles with and travel expenses from Hoffmann-La Roche and Roche Netherlands.
Perspective
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Ashley L. Sumrall, MD
In this study, we have a rare opportunity to follow patients with low-grade gliomas (both grade 1 and grade 2 lesions) over a long period of time. Evaluations of both general and disease-specific health-related quality of life were performed at 6 years and 12 years after initial treatment. Of the 195 patients enrolled, a disappointing 67 were included in the long-term follow-up, 58 patients died, and 45 patients progressed or had additional therapy.
Two patients later were excluded for incomplete data, leaving 65 patients in the final analysis. Most of them had grade II lesions, which can exhibit markedly different behaviors than grade I tumors. Unfortunately, results are not further stratified by grade of tumor. The reported data could be further enhanced by reporting 1p19q status for those tumors with an oligodendroglial component. Regardless, we do learn that patients with low-grade gliomas have statistically significant impairment of general health perceptions and physical role functioning. We also learn that the group disproved its prior theory that female patients and those with more frequent seizures had worse quality of life.
As the spotlight turns to low-grade primary brain tumors, we have to attack problems in different ways than we manage higher grade tumors. This is difficult to do with the paucity of evidence on long-term survivors. Understanding such intangible factors as psychosocial functioning, seizure frequency, headaches and mental health can only improve the care of these patients. These authors are to be applauded for their steadfast dedication to this disease for many years.
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