Patient-reported factors that influence the vestibular schwannoma treatment decision: a qualitative study

Management of treatment-naïve Koos grade IV vestibular schwannomas using hypofractionated Gamma Knife radiosurgery: a retrospective single-institution study

While single-fraction Gamma Knife radiosurgery (GKRS) has shown efficacy in managing vestibular schwannomas (VSs), some concerns have been raised regarding its safety profile, particularly in the context of hearing preservation. Hypofractionation has emerged as a promising approach to improving the safety profile. This retrospective, single-institution study evaluated patient outcomes following hypofractionated GKRS (hf-GKRS) for treatment-naïve Koos grade IV VSs. This study involved all patients with treatment-naïve Koos grade IV VSs who underwent hf-GKRS (3 or 5 fractions) between January 2018 and June 2021, with a follow-up period of ≥ 36 months. The outcomes assessed included local control (LC), the preservation of serviceable hearing as determined by the Gardner-Robertson hearing scale, and procedure-related adverse events. Twenty-nine patients (14 females, median age 49 years) were treated with three different dose regimens: 21 patients received 18 Gy in 3 fractions, 6 patients received 20 Gy in 5 fractions, and 2 patients received 25 Gy in 5 fractions. Prior to treatment, 13 patients (44.8%) had serviceable hearing, one (3.4%) presented with facial palsy, and four (13.8%) had trigeminal nerve dysfunction. The median tumor volume was 10.8 cm3. During a median radiological follow-up period of 60 months (range, 36-78 months), LC was achieved in all patients. All 13 patients retained serviceable hearing at the last follow-up. Trigeminal nerve dysfunction occurred in one patient (3.4%), while another patient (3.4%) needed a ventriculoperitoneal shunt insertion due to new-onset hydrocephalus. No new-onset facial palsy was observed. hf-GKRS shows promise as an effective and safe primary or adjuvant treatment for Koos grade IV VSs with non-life-threatening or debilitating symptoms. Future studies with larger cohorts and extended follow-up periods are needed to validate these findings and to refine fractionation schemes.

Long-Term Quality of Life of Vestibular Schwannoma Patients: A Longitudinal Analysis

OBJECTIVE

Vestibular schwannoma management aims to maintain optimal quality of life (QoL) while preventing severe sequelae of the tumor or its treatment. This study assessed long-term QoL of patients with vestibular schwannoma in relation to treatment modality and decisional regret.

STUDY DESIGN

A longitudinal study, in which clinical and QoL data were used that were cross-sectionally acquired in 2014 and again in 2020 from the same patient group.

SETTING

A tertiary expert center for vestibular schwannoma care in the Netherlands.

METHODS

QoL was measured by the Penn Acoustic Quality of Life (PANQOL) scale. Changes in time were assed using a linear mixed model. In addition, the Decision Regret Scale was analyzed.

RESULTS

Of 867 patients, 536 responded (62%), with a median follow-up of 11 years. All PANQOL subdomain scores remained stable over time and did not exceed minimal clinically important difference (MCID) levels. Time since treatment did not affect QoL. Patients had comparable average QoL scores and proportions of patients with changing QoL scores (ie, exceeding the MCID) over time, irrespective of the received initial treatment. Female patients and those who required salvage therapy (either by radiotherapy or surgery) reported a lower QoL. The latter patient group reported the highest decisional regret.

CONCLUSION

On average, the long-term QoL of patients with vestibular schwannoma is comparable for patients under active surveillance and those who have received active treatment, and it remains stable over time. This suggests that, on average, preservation of QoL of patients with vestibular schwannoma is feasible when adequately managed.

Effect of Narrative Nursing Intervention Based on Targeted Nursing Intervention on Anxiety and Nursing Satisfaction of Patients with Malignant Tumors Undergoing Chemotherapy

Objective

To explore the effect of narrative nursing intervention based on targeted nursing intervention on anxiety and nursing satisfaction of patients with malignant tumors undergoing chemotherapy.

Methods

120 malignant tumor patients treated with chemotherapy in our hospital from January 2019 to January 2020 were selected as the research objects and randomly divided into group A and group B, with 60 cases in each group. The targeted nursing intervention was performed to group B, and the targeted nursing intervention centering on narrative nursing was performed to group A, so as to compare their distress thermometer (DT) scale scores, depression and anxiety scale scores, Medical Coping Modes Questionnaire (MCMQ) scores, Functional Assessment of Cancer Therapy-General (FACT-G) scores for quality of life, and nursing satisfaction.

Results

After nursing intervention, group A obtained 5.00 ± 1.20 points in the DT score, which were significantly lower than group B (P < 0.05); and group A achieved significantly lower depression and anxiety scale scores (P < 0.001), better MCMQ scores (P < 0.05), and higher FACT-G scores (P < 0.05) and nursing satisfaction (P < 0.05) than group B.

Conclusion

The targeted nursing intervention based primarily on narrative nursing can greatly reduce negative emotions, alleviate anxiety, and improve confidence in treatment and quality of life for malignant tumor patients undergoing chemotherapy, with higher nursing satisfaction, which should be promoted and applied in the practice.

Shared decision-making in neurosurgery: a scoping review

BACKGROUND

In modern neurosurgery, there are often several treatment alternatives, with different risks and benefits. Shared decision-making (SDM) has gained interest during the last decade, although SDM in the neurosurgical field is not widely studied. Therefore, the aim of this scoping review was to present the current landscape of SDM in neurosurgery.

METHODS

A literature review was carried out in PubMed and Scopus. We used a search strategy based on keywords used in existing literature on SDM in neurosurgery. Full-text, peer-reviewed articles published from 2000 up to the search date February 16, 2021, with patients 18 years and older were included if articles evaluated SDM in neurosurgery from the patient's perspective.

RESULTS

We identified 22 articles whereof 7 covered vestibular schwannomas, 7 covered spinal surgery, and 4 covered gliomas. The other topics were brain metastases, benign brain lesions, Parkinson's disease and evaluation of neurosurgical care. Different methods were used, with majority using forms, questionnaires, or interviews. Effects of SDM interventions were studied in 6 articles; the remaining articles explored factors influencing patients' decisions or discussed SDM aids.

CONCLUSION

SDM is a tool to involve patients in the decision-making process and considers patients' preferences and what the patients find important. This scoping review illustrates the relative lack of SDM in the neurosurgical literature. Even though results indicate potential benefit of SDM, the extent of influence on treatment, outcome, and patient's satisfaction is still unknown. Finally, the use of decision aids may be a meaningful contribution to the SDM process.

The impact of vestibular schwannoma and its management on employment

BACKGROUND

Employment is an important factor in quality of life. For vestibular schwannoma (VS) patients, employment is not self-evident, because of the sequelae of the disease or its treatment and their effects on daily life.

OBJECTIVES

This study assessed employment status, sick leave (absenteeism) and being less productive at work (presenteeism) in the long-term follow-up of VS patients, and evaluated the impact of treatment strategy (active surveillance, surgery or radiotherapy).

METHODS

A cross-sectional survey study was performed in a tertiary university hospital in the Netherlands. Patients completed the iMTA-post productivity questionnaire (iPCQ). Employment status was compared to that of the general Dutch population. Employment, absenteeism and presenteeism were compared between patients under active surveillance, patients after radiotherapy and post-surgical patients.

RESULT

In total 239 patients participated, of which 67% were employed at the time of the study. Only 14% had a disability pension, which was comparable to the age-matched general Dutch population. The proportion of patients with absenteeism was 8%, resulting in a 4% reduction of working hours. Presenteeism was reported by 14% of patients, resulting in a 2% reduction of working hours. The median number of working hours per week was 36, and since the diagnosis, these hours had been reduced by 6%. There were no significant differences between treatment modalities.

CONCLUSION

On average, long-term employment status and working hours of VS patients are comparable to the age-matched general population. Treatment strategies do not seem to differentially impact on long-term employment of VS patients.