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Chakravarti S, Gupta SR, Myneni S, Elshareif M, Rogers JL, Caraway C, Ahmed AK, Schreck KC, Kamson DO, Holdhoff M, Croog V, Redmond KJ, Bettegowda C, Mukherjee D. Clinical Outcome Assessment Tools for Evaluating the Management of Gliomas. Cancers (Basel) 2025; 17:1659. [PMID: 40427156 PMCID: PMC12110255 DOI: 10.3390/cancers17101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2025] [Revised: 05/08/2025] [Accepted: 05/10/2025] [Indexed: 05/29/2025] Open
Abstract
In recent times, a greater emphasis has been placed on framing patient clinical assessments and QOL as both endpoints and prognostic factors for neuro-oncological care. However, there is currently a lack of consensus on the most effective metrics and instruments for use in patients with primary brain tumors. Due to the heterogeneity in clinical characteristics, histological classification, anatomical location, and available treatment modalities for glioma, quantifying patient clinical condition and QOL within this unique population is particularly challenging. In this paper, we comprehensively review the available literature on the use of clinical assessment tools in glioma patients, highlighting the strengths and limitations of prominent instruments. We demonstrate that clinical outcome assessment (COA) instruments provide valuable and complementary insights into the physical, psychological, and spiritual well-being of glioma patients.
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Affiliation(s)
- Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sneha R. Gupta
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Saket Myneni
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Mazin Elshareif
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - James L. Rogers
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Chad Caraway
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - A. Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Karisa C. Schreck
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - David O. Kamson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Matthias Holdhoff
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Victoria Croog
- Department of Radiation Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Kristin J. Redmond
- Department of Radiation Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Zhang S, Zhang F, Chen H, Wang L, Jiang X. Effects of a Comprehensive Program on Reducing Cancer-Related Fatigue: A Randomized Controlled Trial. J Pain Symptom Manage 2025; 69:331-342. [PMID: 39709135 DOI: 10.1016/j.jpainsymman.2024.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 11/27/2024] [Accepted: 12/06/2024] [Indexed: 12/23/2024]
Abstract
CONTEXT Cancer-related fatigue (CRF) can affect patients undergoing chemotherapy severely. A comprehensive intervention targeted for reducing CRF is lacking. OBJECTIVES To evaluate the effectiveness of an innovative multifaceted web-based patient-empowered CRF management program for improving CRF, perceived self-efficacy for fatigue self-management (PSEFSM), physical activity, quality of sleep, anxiety, depression, pain and quality of life (QoL) among gastric cancer patients undergoing chemotherapy in China. METHODS A total of 92 eligible gastric cancer patients undergoing chemotherapy were recruited and randomly assigned to two groups. Participants in the intervention group received a 12-week CRF intervention including eight online sessions, patient diary for self-management practice; telephone follow-up and online support via WeChat. The control group received routine care. Primary outcome was CRF. Secondary outcomes included PSEFSM, physical activity, quality of sleep, anxiety, depression, pain, and QoL. Outcome variables were measured three times: at admission(T0), post-intervention(T1) and one-month post-intervention(T2). Repeated measures ANOVA or generalized estimating equations were used to evaluate the intervention effect. RESULTS Significant group by time interaction was found in the scores of total CRF and its three dimensions, PSEFSM, total physical activities, quality of sleep, anxiety, depression, and QoL of the two groups (P <0.05). No significant difference was found in pain scores (P >0.05). CONCLUSION This study provides evidence that an innovative multifaceted web-based patient-empowered CRF management program is effective in reducing CRF and improving related symptoms (depression, anxiety, quality of sleep), physical activity, PSEFSM and QoL for gastric cancer patients undergoing chemotherapy.
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Affiliation(s)
- Shijiao Zhang
- West China School of Nursing (S.Z., X.J.), Sichuan University/West China Hospital, Sichuan University, Chengdu, China
| | - Feifei Zhang
- Shanghai Jiao Tong University School of Nursing (F.Z.), Shanghai, China
| | - Hong Chen
- Evidence-Based Nursing Center (H.C.), West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lei Wang
- Nursing Department (L.W.), West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaolian Jiang
- West China School of Nursing (S.Z., X.J.), Sichuan University/West China Hospital, Sichuan University, Chengdu, China.
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Natsume K, Yoshida A, Sakakima H, Yonezawa H, Kawamura K, Akihiro S, Hanaya R, Shimodozono M. Age-independent benefits of postoperative rehabilitation during chemoradiotherapy on functional outcomes and survival in patients with glioblastoma. J Neurooncol 2024; 170:129-137. [PMID: 39078543 PMCID: PMC11447139 DOI: 10.1007/s11060-024-04785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE To investigate the impact of early and continuous postoperative inpatient rehabilitation during chemoradiotherapy on functional outcomes and overall survival (OS) in patients with glioblastoma (GBM), particularly in different age groups. METHODS This retrospective cohort study at a university hospital (2011-2016) included 75 of 119 consecutive patients newly diagnosed with GBM who underwent standardized treatment and postoperative rehabilitation. Patients were divided into older (≥ 65 years, n = 45) and younger (< 65 years, n = 30) groups, engaging in a 50-day rehabilitation program. We assessed rehabilitation progress, Barthel Index (BI), Brunnstrom Recovery Stage (BRS), adverse events, and OS. BI at discharge and survival were analyzed using multivariate and Cox regression models, respectively. RESULTS The mean age was 72.5 ± 6.3 and 52.4 ± 7.8 years in the older and younger groups, respectively. Both groups demonstrated significant improvements in BI and BRS. Despite more adverse events in the older group, no significant difference existed in median OS (older group: 18.7 months vs. younger group: 18.3 months, p = 0.87). Early walking training, reduced fatigue during chemoradiotherapy, and high Karnofsky Performance Status at admission significantly impacted the BI at discharge. Cox regression analysis identified the BI at discharge as a significant predictor of survival (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.97-0.99, p = 0.008). CONCLUSION Integrated rehabilitation improves functional outcomes, and enhanced ADL at discharge is associated with improved survival outcomes in patients with GBM, regardless of age. This highlights the need for personalized rehabilitation in treatment protocols. Further prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Keisuke Natsume
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Akira Yoshida
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hajime Yonezawa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kentaro Kawamura
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shintaro Akihiro
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Gunn HJ, Zaniletti I, Breen WG, Leavitt T, Bogan A, Mahajan A, Brown PD, Yan E, Vora SA, Merrell KW, Ashman JB, Peterson JL, Leenstra JL, Wilson ZC, Laughlin BS, Laack NN, DeWees TA. Establishing the minimal clinically important difference of the Brief Fatigue Inventory for brain or CNS cancer patients undergoing radiotherapy. Neurooncol Pract 2024; 11:633-639. [PMID: 39279768 PMCID: PMC11398933 DOI: 10.1093/nop/npae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background Minimal clinically important differences (MCIDs) quantify the clinical relevance of quality of life results at the individual patient and group level. The aim of this study was to estimate the MCID for the Brief Fatigue Inventory (BFI) and the Worst and Usual Fatigue items in patients with brain or CNS cancer undergoing curative radiotherapy. Methods Data from a multi-site prospective registry was used. The MCID was calculated using distribution-based and anchor-based approaches. For the anchor-based approach, the fatigue item from the PROMIS-10 served as the anchor to determine if a patient improved, deteriorated, or had no change from baseline to end of treatment (EOT). We compared the unadjusted means on the BFI for the 3 groups to calculate the MCID. For the distribution-based approaches, we calculated the MCID as 0.5 SD of the scores and as 1.96 times the standard error of measurement. Results Three-hundred and fifty nine patients with brain or CNS tumors undergoing curative radiotherapy filled out the 9-item BFI at baseline and EOT. The MCID for the BFI was 1.33 (ranging from 0.99 to 1.70 across the approaches), 1.51 (ranging from 1.16 to 2.02) and 1.76 (ranging from 1.38 to 2.14) for the usual and worst fatigue items, respectively. Conclusions This study provides the MCID ranges for the BFI and Worst and Usual fatigue items, which will allow clinically meaningful conclusions to be drawn from BFI scores. These results can be used to select optimal treatments for patients with brain or CNS cancer or to interpret BFI scores from clinical trials.
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Affiliation(s)
- Heather J Gunn
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | | | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aaron Bogan
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Kenneth W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - James L Leenstra
- Department of Radiation Oncology, Mayo Clinic, Northfield, Minnesota, USA
| | - Zachary C Wilson
- Department of Radiation Oncology, Mayo Clinic, Eau Claire, Wisconsin, USA
| | - Brady S Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd A DeWees
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, California, USA
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Loughan AR, Lanoye A, Willis KD, Fox A, Ravyts SG, Zukas A, Kim Y. Telehealth group Cognitive-Behavioral Therapy for Insomnia (CBT-I) in primary brain tumor: Primary outcomes from a single-arm phase II feasibility and proof-of-concept trial. Neuro Oncol 2024; 26:516-527. [PMID: 37796017 PMCID: PMC10911999 DOI: 10.1093/neuonc/noad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Cognitive-Behavioral Therapy for Insomnia (CBT-I), the frontline treatment for insomnia, has yet to be evaluated among patients with primary brain tumors (PwPBT) despite high prevalence of sleep disturbance in this population. This study aimed to be the first to evaluate the feasibility, safety, and acceptability of implementing telehealth group CBT-I as well as assessing preliminary changes in subjective sleep metrics in PwPBT from baseline to follow-up. METHODS Adult PwPBT were recruited to participate in six 90-min telehealth group CBT-I sessions. Feasibility was assessed by rates of screening, eligibility, enrollment, and data completion. Safety was measured by participant-reported adverse events. Acceptability was assessed by retention, session attendance, satisfaction, recommendation of program to others, and qualitative feedback. Participant subjective insomnia severity, sleep quality, and fatigue were assessed at baseline, post intervention, and 3-month follow-up. RESULTS Telehealth group CBT-I was deemed safe. Following the 76% screening rate, 85% of interested individuals met study eligibility and 98% enrolled (N = 44). Ninety-one percent of enrolled participants completed measures at baseline, 79% at post intervention, and 73% at 3-month follow-up. Overall, there was an 80% retention rate for the 6-session telehealth group CBT-I intervention. All participants endorsed moderate-to-strong treatment adherence and 97% reported improved sleep. Preliminary pre-post intervention effects demonstrated improvements in subjective insomnia severity, sleep quality, and fatigue with large effect sizes. These effects were maintained at follow-up. CONCLUSIONS Results of this proof-of-concept trial indicate that telehealth group CBT-I is feasible, safe, and acceptable among PwPBT, providing support for future randomized controlled pilot trials.
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Affiliation(s)
- Ashlee R Loughan
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Autumn Lanoye
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kelcie D Willis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amber Fox
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Scott G Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alicia Zukas
- Department of Neurosurgery, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
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Verhaak E, Schimmel WCM, Sitskoorn MM, Hanssens PEJ, Butterbrod E, Gehring K. The long-term course and relationship with survival of multidimensional fatigue in patients with brain metastases after Gamma Knife radiosurgery. J Cancer Res Clin Oncol 2023; 149:9891-9901. [PMID: 37249646 PMCID: PMC10423137 DOI: 10.1007/s00432-023-04857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE The aims of this study were to evaluate long-term multidimensional fatigue in patients with brain metastases (BM) up to 21 months after Gamma Knife radiosurgery (GKRS) and (change in) fatigue as predictor of survival. METHODS Patients with 1 to 10 BM, expected survival > 3 months, and Karnofsky Performance Status ≥ 70, and Dutch non-cancer controls were included. Fatigue was measured with the Multidimensional Fatigue Inventory. Levels of fatigue between patients and controls were compared using independent-samples t-tests. Linear mixed models were used to evaluate fatigue within the patient group up to 21 months after GKRS. Pre-GKRS fatigue and minimal clinically important (MCI) changes in fatigue in the first three months (defined as a 2-point difference) after GKRS were evaluated as predictors of survival time. RESULTS Prior to GKRS, patients with BM (n = 92) experienced significantly higher fatigue on all subscales than controls (n = 104). Over 21 months, physical fatigue increased, and mental fatigue decreased significantly. More specifically, general, and physical fatigue increased significantly between pre-GKRS and 3 months, followed by stable scores between 3 (n = 67) and 6 (n = 53), 6 and 12 (n = 34) and 12 and 21 (n = 21) months. An MCI increase in general or physical fatigue over the first 3 months after GKRS was a significant predictor of shorter survival time. CONCLUSION Except for mental fatigue, all aspects of fatigue remained elevated or further increased up to 21 months after treatment. Furthermore, an increase in general or physical fatigue within three months after GKRS may be a prognostic indicator for poorer survival. CLINICALTRIALS GOV IDENTIFIER NCT02953756, November 3, 2016.
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Affiliation(s)
- Eline Verhaak
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands.
| | - Wietske C M Schimmel
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Margriet M Sitskoorn
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Patrick E J Hanssens
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Elke Butterbrod
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karin Gehring
- Department of Neurosurgery-Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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Dadhania S, Pakzad-Shahabi L, Mistry S, Williams M. Triaxial accelerometer-measured physical activity and functional behaviours among people with High Grade Glioma: The BrainWear Study. PLoS One 2023; 18:e0285399. [PMID: 37224155 DOI: 10.1371/journal.pone.0285399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND High-grade gliomas (HGG) account for 60-75% of all adult gliomas. The complexity of treatment, recovery and survivorship creates a need for novel monitoring approaches. Accurate assessment of physical function plays a vital role in clinical evaluation. Digital wearable tools could help us address unmet needs by offering unique advantages such as scale, cost and continuous real-world objective data. We present data from 42 patients enrolled into the BrainWear study. METHODS An AX3 accelerometer was worn by patients from diagnosis or at recurrence. Age-, sex-matched UK Biobank control groups were chosen for comparison. RESULTS 80% of data were categorised as high-quality demonstrating acceptability. Remote, passive monitoring identifies moderate activity reduces both during a course of radiotherapy (69 to 16 minutes/day) and at the time of progressive disease assessed by MRI (72 to 52 minutes/day). Mean acceleration (mg) and time spent walking daily (h/day) correlated positively with the global health quality of life and physical functioning scores and inversely with the fatigue score. Healthy controls walked on average 2.91h/day compared to 1.32h/day for the HGG group on weekdays and 0.91h/day on the weekend. The HGG cohort slept for longer on weekends (11.6h/day) than weekdays (11.2h/day) compared to healthy controls (8.9h/day). CONCLUSION Wrist-worn accelerometers are acceptable and longitudinal studies feasible. HGG patients receiving a course of radiotherapy reduce their moderate activity by 4-fold and are at least half as active as healthy controls at baseline. Remote monitoring can provide a more informed and objective understanding of patient activity levels to help optimise health related quality of life (HRQoL) among a patient cohort with an extremely limited lifespan.
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Affiliation(s)
- Seema Dadhania
- Computational Oncology Group, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Radiotherapy Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Lillie Pakzad-Shahabi
- Computational Oncology Group, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Radiotherapy Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sanjay Mistry
- NIHR Clinical Research Department, Medical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Matt Williams
- Computational Oncology Group, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Radiotherapy Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Belloni S, Arrigoni C, Baroni I, Conte G, Dellafiore F, Ghizzardi G, Magon A, Villa G, Caruso R. Non-pharmacologic interventions for improving cancer-related fatigue (CRF): A systematic review of systematic reviews and pooled meta-analysis. Semin Oncol 2023:S0093-7754(23)00035-0. [PMID: 36973125 DOI: 10.1053/j.seminoncol.2023.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Literature encloses numerous systematic reviews (SRs) on nonpharmacologic interventions for improving cancer-related fatigue (CRF). The effect of these interventions remains controversial, and the available SRs have not been synthesized yet. We conducted a systematic synthesis of SRs and meta-analysis to determine the effect of nonpharmacologic interventions on CRF in adults. MATERIAL AND METHODS We systematically searched 4 databases. The effect sizes (standard mean difference) were quantitatively pooled using a random-effects model. Chi-squared (Q) and I-square statistics (I²) tested the heterogeneity. RESULTS We selected 28 SRs, including 35 eligible meta-analyses. The pooled effect size (standard mean difference, 95% CI) was -0.67 (-1.16, -0.18). The subgroup analysis by types of interventions showed a significant effect in all the investigated approaches (complementary integrative medicine, physical exercise, self-management/e-health interventions). CONCLUSIONS There is evidence that nonpharmacologic interventions are associated with CRF reduction. Future research should focus on testing these interventions on specific population clusters and trajectories. PROSPERO REGISTRATION CRD42020194258.
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Affiliation(s)
- Silvia Belloni
- IRCCS Humanitas Research Hospital, Educational and Research Unit, Rozzano, Italy.
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Greta Ghizzardi
- Health Professions Directorate, Bachelor in Nursing Course, ASST Lodi, Lodi, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
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Zhang X, Li Y, Zhang D, Zhong Y, Li T. Fatigue and Its Contributing Factors in Chinese Patients with Primary Pituitary Adenomas. JOURNAL OF ONCOLOGY 2023; 2023:9876422. [PMID: 36968639 PMCID: PMC10033214 DOI: 10.1155/2023/9876422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/05/2022] [Accepted: 01/29/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Pituitary adenomas (PAs) refers to a group of benign tumors that develop in the pituitary gland and are often characterized by fatigue. However, fatigue has not been documented in any Chinese research involving people with primary PA. The study sought to examine the prevalence, predictors, and correlation of fatigue with the quality of life (QoL) among PA patients in China. METHODS In total, 203 primary PA patients were included in this cross-sectional study. A series of questionnaires were administered, including the Multidimensional Fatigue Inventory (MFI), M. D. Anderson Symptom Inventory Brain Tumor (MDASI-BT), Short-Form 36 Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). Data analysis was accomplished by Pearson or Spearman correlations, linear regression, and simple path analysis. RESULTS Severe fatigue prior to the initial diagnosis and preparation for surgery affected 50% of PA patients. Depression, sleep disturbance, and MDASI-BT symptom total scores were independently able to predict patient fatigue. Sleep disturbance mediates the influence of depression on fatigue (IE sleep = 0.296, 95% CI: LB = 0.148 to UB = 0.471). CONCLUSIONS Chinese patients with primary PA often report experiencing fatigue. Depression and poor sleep quality were shown to be significant contributors to PA patients' fatigue. Depression affects PA patients' fatigue directly or indirectly. Medical professionals should take a proactive approach to PA patients suffering from fatigue before initial diagnosis and preoperative preparation to determine necessary interventions early, thus reducing fatigue and ultimately enhancing their QoL.
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Affiliation(s)
- Xiaomei Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Yanqing Li
- Medical College, Nantong University, 19th Qixiu Road, Nantong 226001, China
| | - Dandan Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
- Medical College, Nantong University, 19th Qixiu Road, Nantong 226001, China
- Department of Nursing, Nantong Health College of Jiangsu Province, 288th Zhenxing East Road, Nantong 226010, China
| | - Yueping Zhong
- Department of Nursing, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong 226001, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, No. 169 Changle West Rd, Xi'an 710032, China
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Simhal RK, Sholklapper TN, Simhal AK, Zwart AL, Danner MT, Kumar D, Aghdam N, Suy S, Hankins RA, Kowalczyk KJ, Collins SP. Association of baseline self-reported fatigue with overall survival after stereotactic body radiation therapy for localized prostate cancer. Front Oncol 2022; 12:1015264. [PMID: 36620537 PMCID: PMC9816795 DOI: 10.3389/fonc.2022.1015264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Stereotactic Body Radiation Therapy (SBRT) has emerged as a definitive therapy for localized prostate cancer (PCa). However, more data is needed to predict patient prognosis to help guide which patients will benefit most from treatment. The FACIT-Fatigue (FACIT-F) is a well validated, widely used survey for assessing fatigue. However, the role of fatigue in predicting PCa survival has yet to be studied. Herein, we investigate the role of FACIT-F as a baseline predictor for overall survival (OS) in patients undergoing SBRT for localized PCa. Methods A retrospective review was conducted of 1358 patients who received SBRT monotherapy between January 2008 to April 2021 at an academic, tertiary referral center. FACIT-F scores (range 0 to 52) were summed for patients who answered all 13-items on the survey. FACIT-F total scores of ≥35 represented severe fatigue. Patients receiving androgen deprivation therapy were excluded. Differences in fatigue groups were evaluated using chi-squared tests. OS rates were determined using the Kaplan-Meier method and predictors of OS were evaluated using Cox proportional hazard method. Results Baseline full FACIT-F scores and survival data was available for 891 patients. 5-year OS was 87.6% and 95.2%, respectively, for the severely fatigued and non-fatigued groups. Chi-squared analysis of fatigue groups showed no significant difference in the following categories: D'Amico risk group, age, ethnicity, grade group, T-stage, or PSA density. Severe fatigue was associated with a significant decrease in OS (hazard ratio 2.76; 95%CI 1.55 - 4.89). The Cox proportional hazard model revealed that age and FACIT-F were both statistically significant (p <0.05). Conclusion Baseline FACIT-F scores are significantly associated with OS. Higher FACIT-F scores, representing less fatigued patients, are associated with an overall survival benefit. These results indicate that the FACIT-F survey could serve as an additional metric for clinicians in determining prognostic factors for patients undergoing SBRT.
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Affiliation(s)
- Rishabh K. Simhal
- School of Medicine, Georgetown University, Washington, DC, United States,*Correspondence: Rishabh K. Simhal,
| | | | - Anish K. Simhal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alan L. Zwart
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Malika T. Danner
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Deepak Kumar
- Julius L. Chambers Research Institute, North Carolina Central University, Durham, NC, United States
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Simeng Suy
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Ryan A. Hankins
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Keith J. Kowalczyk
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Sean P. Collins
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
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11
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Gandy K, Chambers T, Raghubar KP, Fatih Okcu M, Chintagumpala M, Taylor O, Mahajan A, Kahalley LS, Chan W, Grosshans DR, Brown AL, Douglas Ris M. A Prospective Evaluation of Fatigue in Pediatric Brain Tumor Patients Treated With Radiation Therapy. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:358-365. [PMID: 36285825 DOI: 10.1177/275275302110560011068754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Fatigue is a well-established consequence of cranial radiotherapy in survivors of pediatric brain tumor, but less is known about acute fatigue during radiotherapy treatment. This study aimed to longitudinally evaluate fatigue in newly diagnosed pediatric patients with brain tumors during treatment. Methods: Primary caregivers of pediatric patients with brain tumors completed the proxy-reported Parent Fatigue Scale assessments prior to radiotherapy and weekly during radiotherapy treatment. The association between clinical factors and fatigue at each assessment was evaluated with multiple linear regressions. A comparison of fatigue between radiation modalities was also analyzed. Results: A total of 33 caregivers completed pre-radiation fatigue assessments, with 29 reporting fatigue during radiotherapy. Patients were aged 3 to 16 years (M = 8.32) at diagnosis and diagnosed with medulloblastoma (n = 23), primitive neuroectodermal tumor (n = 2), ependymoma (n = 1), germ cell tumor (n = 1), pineoblastoma (n = 1), atypical teratoid rhabdoid (n = 1), and other unspecific tumors (n = 3). Moderate-to-severe fatigue was reported for the majority of patients (31/33; 94%) during treatment. Craniospinal irradiation dose was the only significant predictor of fatigue (p < .05), but this association was restricted to the first week of therapy and was attenuated by therapy completion. Discussion: Although fatigue is often considered a long-term consequence of cranial radiotherapy, this pilot study demonstrates that moderate-to-severe fatigue is pervasive prior to radiotherapy and persists throughout treatment in pediatric patients with brain tumors, regardless of radiation modality or clinical factors. Additional research is warranted to establish a link between acute and long-term fatigue and develop interventions to mitigate this adverse outcome.
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Affiliation(s)
- Kellen Gandy
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Tiffany Chambers
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mehmet Fatih Okcu
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Murali Chintagumpala
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Olga Taylor
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa S Kahalley
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Austin L Brown
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Martin Douglas Ris
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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12
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Kitselaar WM, de Morree HM, Trompenaars MW, Sitskoorn MM, Rutten GJ, Kop WJ. Fatigue after neurosurgery in patients with a brain tumor: The role of autonomic dysregulation and disturbed sleep. J Psychosom Res 2022; 156:110766. [PMID: 35278872 DOI: 10.1016/j.jpsychores.2022.110766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Background Fatigue is prevalent in patients with a brain tumor and high levels of fatigue persist after neurosurgical tumor resection. The underlying mechanisms are insufficiently understood and this study examines the role of autonomic nervous system dysregulation and objective sleep characteristics in fatigue among post-surgical patients. Methods Patients undergoing craniotomy (N = 52; age 52.1 ± 15.0 years; 44% women) were evaluated at 3 months after surgery (median = 86 days). Fatigue was measured using the Multidimensional Fatigue Inventory. Autonomic nervous system indices were based on 24-h heart rate variability (HRV) analysis. Sleep parameters were measured using actigraphy: total sleep duration, efficiency, onset latency and wake after sleep onset (WASO). Data analyses of this cross-sectional study included correlation and multiple regression analysis. Results Fatigue scores were significantly elevated in tumor resection patients compared to healthy reference norms (p's < 0.05) with no differences between patients with glioma (N = 32) versus meningioma (N = 20). Associations between HRV indices and fatigue were non-significant (r values <0.16, p values > 0.25). Sleep duration was associated with physical fatigue (r = 0.35, p = 0.02), whereas WASO was associated with mental fatigue levels (r = 0.40, p = 0.006). Disturbed sleep measures were associated with HRV indices of reduced parasympathetic nervous system activity in glioma patients but not in meningioma patients. Conclusions Multiple nocturnal awakenings may result in mental fatigue and longer sleep time was associated with physical fatigue, which may reflect compensatory sleep patterns. Future intervention studies addressing sleep quality may be beneficial in treating fatigue in patients following neurosurgery for tumor resection.
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Affiliation(s)
- Willeke M Kitselaar
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg, the Netherlands; Department of Health, Medical and Neuropsychology, Leiden University, the Netherlands; Campus Den Haag, LUMC, the Netherlands
| | - Helma M de Morree
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg, the Netherlands
| | - Marjan W Trompenaars
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg, the Netherlands
| | | | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth - TweeSteden Hospital, Tilburg, the Netherlands
| | - Willem J Kop
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg, the Netherlands.
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13
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Miklja Z, Gabel N, Altshuler D, Wang L, Hervey-Jumper SL, Smith S. Exercise improves health-related quality of life sleep and fatigue domains in adult high- and low-grade glioma patients. Support Care Cancer 2022; 30:1493-1500. [PMID: 34532753 PMCID: PMC10182824 DOI: 10.1007/s00520-021-06566-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The impact of exercise on health-related quality of life (HRQOL) in patients with glioma remains unknown. We hypothesized that glioma patients with low exercise tolerance experience more distress in HRQOL sleep and fatigue domains than patients with high tolerance to exercise. METHODS Thirty-eight male and female patients with low- or high-grade glioma treated at a single tertiary care institution participated. Patients completed a validated telephone survey to determine their exercise habits before and following diagnosis. An unpaired t-test was run to measure the interaction between exercise tolerances on HRQOL functional and impairment domains. RESULTS Those with low pre-morbid physical activity levels had more distress in HRQOL sleep and fatigue domains. The effects were independent of plasma brain-derived neurotrophic factor (BDNF) levels and the degree of exercise did not appear to impact plasma BDNF in adult glioma patients. CONCLUSIONS The aim of this study was to examine the significance of exercise habits on perioperative functional outcomes in patients with low-grade or high-grade glioma. We found that glioma patients with low tolerance to exercise had more sleep disturbances and greater fatigue than glioma patients with high tolerance to exercise. Furthermore, exercise tolerance in the adult glioma population does not appear to impact plasma BDNF secretion.
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Affiliation(s)
- Zachary Miklja
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicolette Gabel
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI, USA
| | - David Altshuler
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Lin Wang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Sean Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI, USA.
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14
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Ammanuel SG, Almeida NC, Kurteff G, Kakaizada S, Molinaro AM, Berger MS, Chang EF, Hervey-Jumper SL. Correlation of natural language assessment results with health-related quality of life in adult glioma patients. J Neurosurg 2022; 136:343-349. [PMID: 34330100 PMCID: PMC10182825 DOI: 10.3171/2021.1.jns203387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Impairments of speech are common in patients with glioma and negatively impact health-related quality of life (HRQoL). The benchmark for clinical assessments is task-based measures, which are not always feasible to administer and may miss essential components of HRQoL. In this study, the authors tested the hypothesis that variations in natural language (NL) correlate with HRQoL in a pattern distinct from task-based measures of language performance. METHODS NL use was assessed using audio samples collected unobtrusively from 18 patients with newly diagnosed low- and high-grade glioma. NL measures were calculated using manual segmentation and correlated with Quality of Life in Neurological Disorders (Neuro-QoL) outcomes. Spearman's rank-order correlation was used to determine relationships between Neuro-QoL scores and NL measures. RESULTS The distribution of NL measures across the entire patient cohort included a mean ± SD total time speaking of 11.5 ± 2.20 seconds, total number of words of 27.2 ± 4.44, number of function words of 10.9 ± 1.68, number of content words of 16.3 ± 2.91, and speech rate of 2.61 ± 0.20 words/second. Speech rate was negatively correlated with functional domains (rho = -0.62 and p = 0.007 for satisfaction with social roles; rho = -0.74 and p < 0.001 for participation in social roles) but positively correlated with impairment domains (rho = 0.58 and p = 0.009 for fatigue) of Neuro-QoL. CONCLUSIONS Assessment of NL at the time of diagnosis may be a useful measure in the context of treatment planning and monitoring outcomes for adult patients with glioma.
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Affiliation(s)
| | | | - Garret Kurteff
- 1Department of Neurological Surgery and.,2Department of Communication Sciences & Disorders, University of Texas, Austin, Texas
| | | | | | | | - Edward F Chang
- 1Department of Neurological Surgery and.,3Center for Integrative Neuroscience, University of California, San Francisco, California; and
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15
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Peters KB, Affronti ML, Woodring S, Lipp E, Healy P, Herndon JE, Miller ES, Freeman MW, Randazzo DM, Desjardins A, Friedman HS. Effects of low-dose naltrexone on quality of life in high-grade glioma patients: a placebo-controlled, double-blind randomized trial. Support Care Cancer 2022; 30:3463-3471. [PMID: 35001215 DOI: 10.1007/s00520-021-06738-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE At diagnosis and throughout the disease course, patients with high-grade glioma (HGG) experience a diminished quality of life (QOL) and increased fatigue. Naltrexone, an orally semisynthetic opiate antagonist, is FDA-approved for the treatment of heroin/alcohol addiction, and low-dose naltrexone (LDN) has been observed to improve QOL and lower fatigue in other neurological illnesses, such as multiple sclerosis. LDN is believed to function as a partial agonist and can lead to shifts in neurochemicals that reduce fatigue. Based on this, we sought to study whether LDN has an impact on QOL and fatigue in patients with HGG. METHODS In a placebo-controlled, double-blind study, we randomized 110 HGG patients to receive placebo (N = 56) or LDN 4.5 mg orally at night (N = 54). Subjects received LDN or placebo at day 1 of concurrent radiation and temozolomide therapy and continued for 16 weeks. Change from baseline in patient-reported outcomes of QOL (Functional Assessment of Cancer Therapy-Brain) and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) was assessed. RESULTS Demographics were WHO grade IV (85%), male (56%), KPS 90-100 (51%), grossly resected (55%), and mean age of 56 years. QOL and fatigue changes between baseline and post concurrent chemotherapy and radiation therapy were not significantly different between patients receiving LDN or placebo. The adverse event profiles for LDN and placebo were similar and attributed to concomitant use of temozolomide. CONCLUSIONS LDN has no effect on QOL and fatigue in HGG patients during concurrent chemotherapy and radiation therapy. TRIAL REGISTRATION United States National Library of Medicine Clinical Trials.gov NCT01303835, Date 2/25/2011.
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Affiliation(s)
- Katherine B Peters
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA. .,Department of Neurology, Duke University Medical Center, Durham, NC, USA.
| | - Mary L Affronti
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA.,Duke School of Nursing, Duke University Medical Center, Durham, NC, USA
| | - Sarah Woodring
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Eric Lipp
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Patrick Healy
- Department of Biostatistics and Informatics, Duke University Medical Center, Durham, NC, USA
| | - James E Herndon
- Department of Biostatistics and Informatics, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth S Miller
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Maria W Freeman
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Dina M Randazzo
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA.,Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Annick Desjardins
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA.,Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Henry S Friedman
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
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16
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Lei J, Zhou Z. Efficacy and safety of bevacizumab combined with temozolomide in the treatment of recurrent malignant gliomas and its influence on serum tumor markers. Am J Transl Res 2021; 13:13886-13893. [PMID: 35035729 PMCID: PMC8748084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of bevacizumab (Bz) combined with temozolomide (TMZ) in the treatment of recurrent malignant gliomas and its influence on serum tumor markers (STMs). METHODS The clinical data of 73 patients with recurrent malignant gliomas admitted to the First People's Hospital of Shuangliu District from April 2016 to June 2018 were analyzed retrospectively. Patients were divided into two groups according to different therapies: the control group (n=33) treated with TMZ, and the research group (n=40) treated with Bz combined with TMZ (Bz+TMZ). The overall response rate (ORR), disease control rate (DCR) and incidence of adverse reactions (ARs) were observed after 4 courses of treatment. The levels of STMs were detected. Additionally, the Karnofsky Performance Scale (KPS) score and quality of life (QoL) before and after treatment were compared between the two groups. The 1-year and 2-year survival rates as well as median survival time (MST) were also compared after 2-year follow-up. Treatment satisfaction was recorded and compared. RESULTS After treatment, the research group exhibited better ORR and DCR than the control group; The incidence of ARs differed insignificantly between the two arms; The serum levels of Vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and transforming growth factor β (TGF-β) in the research group were statistically lower than those in the control group; The KPS score and QoL score increased significantly in both arms, and were higher in the research group compared with the control group; the research group was also superior to the control group in treatment satisfaction. The research group showed higher 1-year and 2-year survival rates than the control group. CONCLUSIONS BZ+TMZ is effective in treating recurrent malignant gliomas, which can improve the QoL and survival of patients.
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17
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Frances SM, Velikova G, Klein M, Short SC, Murray L, Wright JM, Boele F. Long-term impact of adult WHO grade II or III gliomas on health-related quality of life: A systematic review. Neurooncol Pract 2021; 9:3-17. [PMID: 35087674 PMCID: PMC8789291 DOI: 10.1093/nop/npab062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Glioma diagnosis can be devastating and result in a range of symptoms. Relatively little is known about the long-term health-related quality of life (HRQOL) challenges faced by these patients. Establishing the impact of diagnosis on HRQOL could help positively tailor clinical decision making regarding patient support and treatment. The aim of this review is to identify the long-term HRQOL issues reported at least 2 years following diagnosis of WHO grade II/III glioma. Method Systematic literature searches were carried out using Medline, EMBASE, CINAHL, PsycINFO, and Web of Science Core Collection. Searches were designed to identify patient self-reports on HRQOL aspects defined as physical, mental, or social issues. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Narrative synthesis was used to collate findings. Results The search returned 8923 articles. Two hundred seventy-eight titles remained after title and abstract screening, with 21 full-text articles included in the final analysis. The majority of studies used quantitative methods, with 3 articles reporting mixed methodology. Negative emotional/psychological/cognitive changes were the most commonly reported. Physical complaints included fatigue, seizures, and restricted daily activity. Social challenges included strained social relationships and financial problems. Patient coping strategies were suggested to influence patient’s survival quality. Conclusion The consequences of a glioma diagnosis and treatment can have substantial implications for patients’ long-term HRQOL and daily functioning. Findings from this review lay the groundwork for efforts to improve patient HRQOL in long-term survivorship.
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Affiliation(s)
- Sé Maria Frances
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Molecular Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Martin Klein
- Department of Medical Psychology, Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Susan C Short
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Leeds Institute of Molecular Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Louise Murray
- Leeds Institute of Molecular Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Judy M Wright
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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18
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Wang Y, Chen W, Yang T, Zhao B, Zhou L, Kong Z, Wang Y, Dai C, Wang Y, Ma W. Comprehensive ability evaluation and trend analysis of patients with malignant intracranial tumors in the perisurgery period. Brain Behav 2021; 11:e02192. [PMID: 34554656 PMCID: PMC8613416 DOI: 10.1002/brb3.2192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/29/2021] [Accepted: 05/01/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Prognostic situations differ in patients with malignant intracranial tumors. We focused on the quality of life, ability of daily living, and cognitive function of patients in the perisurgery period and investigated the correlation between them and the prognosis of patients. MATERIALS AND METHODS Patients with malignant intracranial tumors admitted to Peking Union Medical College Hospital from May 2018 to August 2020 for surgery were included. The evaluations were performed 6 times in the perisurgery period. The questionnaires for assessment included QLQ-C30, ADL, and so forth. RESULTS A total of 165 patients were included (115 glioma and 50 brain metastases). Patients had their worst performance at the 7-day postsurgical assessment (EORTC QLQ-C30, ADL, HAD-D, Frail Scale, MMSE, MoCA, CSHA-FI, and NANO) and recovered at the 1-month postsurgical assessment (p < .05). Patients with left-sided tumors had significantly worse cognitive function than patients with right-sided tumors before surgery and at 7 days, 1 month, and 6 months after surgery (p < .05). The scores of QLQ-C30 and QLQ-BN20 at 1 month, 3 months, 6 months, and 1 year after surgery were used to reflect the prognosis, and the preoperative MoCA, NANO, CCI, CSHA-FI, and HAD score might predict the quality of life and nutrition status after operation. CONCLUSION The quality of life and daily living ability of patients with malignant intracranial tumors decreased significantly 7 days after the surgery but recovered 1 month after the surgery. Patients with left hemisphere lesions had a worse cognitive function, while the ADL is associated with short-term prognosis. The comprehensive evaluation of the perisurgical period can indicate the prognosis of patients and further guide clinical decision-making.
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Affiliation(s)
- Yaning Wang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenlin Chen
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianrui Yang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghao Zhao
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lizhou Zhou
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziren Kong
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuekun Wang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congxin Dai
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenbin Ma
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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19
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Tabor JK, Bonda D, LeMonda BC, D'Amico RS. Neuropsychological outcomes following supratotal resection for high-grade glioma: a review. J Neurooncol 2021; 152:429-437. [PMID: 33745058 DOI: 10.1007/s11060-021-03731-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Supratotal resection (SpTR) of high-grade glioma (HGG), in which surgical removal of the tumor is extended outside the margins of the preoperative radiographic abnormality, has been suggested to improve overall survival (OS) and progression free survival (PFS) in patients harboring tumors of non-eloquent cortex when compared to gross total resection (GTR). While current literature demonstrates these findings without an increase in post-operative complications or neurological deficits, there remains a paucity of data examining the neuropsychological outcomes of SpTR for HGG. As quality of life dramatically influences survival rates in these patients, it is crucial for neurosurgeons, neuro-oncologists, and neuropsychiatrists to understand the behavioral and cognitive outcomes following SpTR, such that optimal treatment strategies can be tailored for each patient. METHODS We performed a comprehensive review of the available literature regarding survival, neuropsychological, and quality of life (QOL) outcomes following SpTR for HGG. We also review neuropsychological and QOL outcomes following GTR for HGG to serve as a framework for better understanding potential implications of SpTR. RESULTS While results are limited following SpTR for HGG, available data suggests similar outcomes to those seen in patients undergoing GTR of HGG, as well as low-grade glioma. These include a short-term decline in neuropsychological functioning post-surgically with a return to baseline across most neurocognitive domains occurring within several months. Memory and attention remain relatively diminished at long term follow-up. CONCLUSIONS Limited data exist examining postoperative cognitive and behavioral outcomes following SpTR for HGG. While the available data suggests a return to baseline for many neurocognitive domains, attention and memory deficits may persist. However, sample sizes are relatively small and have not been examined in the context of QOL and OS/PFS. More rigorous pre- and post-surgical neuropsychological assessment will help shed light on the long-term cognitive and behavioral effects of SpTR in the setting of HGG and inform clinical care and counseling when SpTR is considered.
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Affiliation(s)
- Joanna K Tabor
- SUNY Downstate College of Medicine, Brooklyn, NY, USA.,Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA
| | - David Bonda
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA
| | - Brittany C LeMonda
- Department of Neurology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra, New York, NY, USA.
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20
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Efficace F, Collins GS, Cottone F, Giesinger JM, Sommer K, Anota A, Schlussel MM, Fazi P, Vignetti M. Patient-Reported Outcomes as Independent Prognostic Factors for Survival in Oncology: Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:250-267. [PMID: 33518032 DOI: 10.1016/j.jval.2020.10.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/05/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Assessment of patient-reported outcomes (PROs) in oncology is of critical importance because it provides unique information that may also predict clinical outcomes. METHODS We conducted a systematic review of prognostic factor studies to examine the prognostic value of PROs for survival in cancer. A systematic literature search was performed in PubMed for studies published between 2013 and 2018. We considered any study, regardless of the research design, that included at least 1 PRO domain in the final multivariable prognostic model. The protocol (EPIPHANY) was published and registered in the International Prospective Register of Systematic Reviews (CRD42018099160). RESULTS Eligibility criteria selected 138 studies including 158 127 patients, of which 43 studies were randomized, controlled trials. Overall, 120 (87%) studies reported at least 1 PRO to be statistically significantly prognostic for overall survival. Lung (n = 41, 29.7%) and genitourinary (n = 27, 19.6%) cancers were most commonly investigated. The prognostic value of PROs was investigated in secondary data analyses in 101 (73.2%) studies. The EORTC QLQ-C30 questionnaire was the most frequently used measure, and its physical functioning scale (range 0-100) the most frequent independent prognostic PRO, with a pooled hazard ratio estimate of 0.88 per 10-point increase (95% CI 0.84-0.92). CONCLUSIONS There is convincing evidence that PROs provide independent prognostic information for overall survival across cancer populations and disease stages. Further research is needed to translate current evidence-based data into prognostic tools to aid in clinical decision making.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy.
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sommer
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Amelie Anota
- French National Platform Quality of Life and Cancer, Besançon, France; Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Michael Maia Schlussel
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paola Fazi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
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21
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Kim AH, Tatter S, Rao G, Prabhu S, Chen C, Fecci P, Chiang V, Smith K, Williams BJ, Mohammadi AM, Judy K, Sloan A, Tovar-Spinoza Z, Baumgartner J, Hadjipanayis C, Leuthardt EC. Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation. Neurosurgery 2021; 87:E338-E346. [PMID: 32315434 PMCID: PMC7534487 DOI: 10.1093/neuros/nyaa071] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/28/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System
(LAANTERN) is an ongoing multicenter prospective NeuroBlate (Monteris Medical) LITT
(laser interstitial thermal therapy) registry collecting real-world outcomes and
quality-of-life (QoL) data. OBJECTIVE To compare 12-mo outcomes from all subjects undergoing LITT for intracranial
tumors/neoplasms. METHODS Demographics, intraprocedural data, adverse events, QoL, hospitalizations, health
economics, and survival data are collected; standard data management and monitoring
occur. RESULTS A total of 14 centers enrolled 223 subjects; the median follow-up was 223 d. There were
119 (53.4%) females and 104 (46.6%) males. The median age was 54.3 yr (range 3-86) and
72.6% had at least 1 baseline comorbidity. The median baseline Karnofsky Performance
Score (KPS) was 90. Of the ablated tumors, 131 were primary and 92 were metastatic. Most
patients with primary tumors had high-grade gliomas (80.9%). Patients with metastatic
cancer had recurrence (50.6%) or radiation necrosis (40%). The median postprocedure
hospital stay was 33.4 h (12.7-733.4). The 1-yr estimated survival rate was 73%, and
this was not impacted by disease etiology. Patient-reported QoL as assessed by the
Functional Assessment of Cancer Therapy-Brain was stabilized postprocedure. KPS declined
by an average of 5.7 to 10.5 points postprocedure; however, 50.5% had
stabilized/improved KPS at 6 mo. There were no significant differences in KPS or QoL
between patients with metastatic vs primary tumors. CONCLUSION Results from the ongoing LAANTERN registry demonstrate that LITT stabilizes and
improves QoL from baseline levels in a malignant brain tumor patient population with
high rates of comorbidities. Overall survival was better than anticipated for a
real-world registry and comparative to published literature.
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Affiliation(s)
- Albert H Kim
- Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Steven Tatter
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ganesh Rao
- Department of Neurosurgery, University of Texas MDA Cancer Center, Houston, Texas
| | - Sujit Prabhu
- Department of Neurosurgery, University of Texas MDA Cancer Center, Houston, Texas
| | - Clark Chen
- Department of Neurosurgery, University of California San Diego, San Diego, California.,Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Peter Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Veronica Chiang
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Kris Smith
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | | | - Kevin Judy
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew Sloan
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | | | - Eric C Leuthardt
- Department of Neurosurgery, Washington University, St. Louis, Missouri
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22
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Wilson HE, Stanton DA, Rellick S, Geldenhuys W, Pistilli EE. Breast cancer-associated skeletal muscle mitochondrial dysfunction and lipid accumulation is reversed by PPARG. Am J Physiol Cell Physiol 2021; 320:C577-C590. [PMID: 33439777 DOI: 10.1152/ajpcell.00264.2020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The peroxisome proliferator-activated receptors (PPARs) have been previously implicated in the pathophysiology of skeletal muscle dysfunction in women with breast cancer (BC) and animal models of BC. This study investigated alterations induced in skeletal muscle by BC-derived factors in an in vitro conditioned media (CM) system and tested the hypothesis that BC cells secrete a factor that represses PPAR-γ (PPARG) expression and its transcriptional activity, leading to downregulation of PPARG target genes involved in mitochondrial function and other metabolic pathways. We found that BC-derived factors repress PPAR-mediated transcriptional activity without altering protein expression of PPARG. Furthermore, we show that BC-derived factors induce significant alterations in skeletal muscle mitochondrial function and lipid accumulation, which are rescued with exogenous expression of PPARG. The PPARG agonist drug rosiglitazone was able to rescue BC-induced lipid accumulation but did not rescue effects of BC-derived factors on PPAR-mediated transcription or mitochondrial function. These data suggest that BC-derived factors alter lipid accumulation and mitochondrial function via different mechanisms that are both related to PPARG signaling, with mitochondrial dysfunction likely being altered via repression of PPAR-mediated transcription, and lipid accumulation being altered via transcription-independent functions of PPARG.
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Affiliation(s)
- Hannah E Wilson
- MD/PhD Medical Scientist Program, West Virginia University School of Medicine, Morgantown, West Virginia.,Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia
| | - David A Stanton
- Department of Human Performance, Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Stephanie Rellick
- Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia.,Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Werner Geldenhuys
- Department of Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, West Virginia
| | - Emidio E Pistilli
- Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia.,Department of Human Performance, Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia.,Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, West Virginia.,West Virginia Clinical and Translational Sciences Institute, West Virginia University School of Medicine, Morgantown, West Virginia
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23
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Al Maqbali M, Al Sinani M, Al Naamani Z, Al Badi K, Tanash MI. Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2021; 61:167-189.e14. [PMID: 32768552 DOI: 10.1016/j.jpainsymman.2020.07.037] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer. OBJECTIVES The objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer. METHODS The following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. RESULTS A total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45-53) with significant heterogeneity between studies (P < 0.000; τ2 = 0.0000; I2 = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue. CONCLUSION This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.
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Affiliation(s)
| | - Mohammed Al Sinani
- Reproductive and Developmental Biology Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zakariya Al Naamani
- School of Nursing and Midwifery, Queen's University Medical Biology Centre, Belfast, Northern Ireland
| | - Khalid Al Badi
- Al Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Mu'ath Ibrahim Tanash
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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24
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Wilson HE, Stanton DA, Montgomery C, Infante AM, Taylor M, Hazard-Jenkins H, Pugacheva EN, Pistilli EE. Skeletal muscle reprogramming by breast cancer regardless of treatment history or tumor molecular subtype. NPJ Breast Cancer 2020; 6:18. [PMID: 32550263 PMCID: PMC7272425 DOI: 10.1038/s41523-020-0162-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/08/2020] [Indexed: 12/24/2022] Open
Abstract
Increased susceptibility to fatigue is a negative predictor of survival commonly experienced by women with breast cancer (BC). Here, we sought to identify molecular changes induced in human skeletal muscle by BC regardless of treatment history or tumor molecular subtype using RNA-sequencing (RNA-seq) and proteomic analyses. Mitochondrial dysfunction was apparent across all molecular subtypes, with the greatest degree of transcriptomic changes occurring in women with HER2/neu-overexpressing tumors, though muscle from patients of all subtypes exhibited similar pathway-level dysregulation. Interestingly, we found no relationship between anticancer treatments and muscle gene expression, suggesting that fatigue is a product of BC per se rather than clinical history. In vitro and in vivo experimentation confirmed the ability of BC cells to alter mitochondrial function and ATP content in muscle. These data suggest that interventions supporting muscle in the presence of BC-induced mitochondrial dysfunction may alleviate fatigue and improve the lives of women with BC.
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Affiliation(s)
- Hannah E. Wilson
- MD/PhD Medical Scientist Program, West Virginia University School of Medicine, Morgantown, WV 26506 USA
- Cancer Institute, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - David A. Stanton
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Cortney Montgomery
- Cancer Institute, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Aniello M. Infante
- Genomics Core Facility, West Virginia University, Morgantown, WV 26506 USA
| | - Matthew Taylor
- West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901 USA
| | - Hannah Hazard-Jenkins
- Department of Surgery, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Elena N. Pugacheva
- Cancer Institute, West Virginia University School of Medicine, Morgantown, WV 26506 USA
- Department of Biochemistry, West Virginia University School of Medicine, Morgantown, WV 26506 USA
| | - Emidio E. Pistilli
- Cancer Institute, West Virginia University School of Medicine, Morgantown, WV 26506 USA
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, WV 26506 USA
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, WV 26506 USA
- West Virginia Clinical and Translational Sciences Institute, West Virginia University School of Medicine, Morgantown, WV 26506 USA
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25
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Wang Y, Zhao B, Chen W, Liu L, Chen W, Zhou L, Kong Z, Dai C, Wang Y, Ma W. Pretreatment Geriatric Assessments of Elderly Patients with Glioma: Development and Implications. Aging Dis 2020; 11:448-461. [PMID: 32257553 PMCID: PMC7069455 DOI: 10.14336/ad.2019.0527] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022] Open
Abstract
Glioma is the most frequent primary brain tumor affecting adults, and the most lethal type is glioblastoma (GBM); currently, the available therapies only provide palliation. The treatments for low-grade glioma (LGG) include neurosurgical resection, watchful waiting, radiotherapy and chemotherapy, while the therapeutic strategies for high-grade glioma (HGG), particularly in elderly patients, have evolved to include radiotherapy, chemotherapy, and targeted monotherapy based on the characteristics of the investigated patients. Proper assessments aiming to predict and achieve the most satisfying prognosis among patients prior to surgery, radiotherapy, chemotherapy, targeted therapy or immunotherapy help summarize the pretreatment characteristics of patients, providing doctors comprehensive information to consider while determining whether the patients could benefit from ongoing treatments and deciding the proper treatment strategy for subsequent phases. This article aims to rigorously review the most recent evidence and discuss current mainstream assessments before the initiation of proper treatments for glioma, thus highlighting the potential necessity of pretreatment assessments.
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Affiliation(s)
- Yaning Wang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghao Zhao
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqi Chen
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Liu
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenlin Chen
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lizhou Zhou
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziren Kong
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congxin Dai
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenbin Ma
- Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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26
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Wong SS, Case LD, Avis NE, Cummings TL, Cramer CK, Rapp SR. Cognitive functioning following brain irradiation as part of cancer treatment: Characterizing better cognitive performance. Psychooncology 2019; 28:2166-2173. [PMID: 31418491 DOI: 10.1002/pon.5202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 08/13/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Although brain radiation therapy (RT) impacts cognitive function, little is known about the subset of survivors with minimal cognitive deficits. This study compares the characteristics of patients receiving brain irradiation as part of cancer treatment with minimal cognitive deficits to those with poorer cognitive functioning. METHODS Adults at least 6 months postbrain RT (N = 198) completed cognitive measures of attention, memory, and executive functions. Cognitive functioning was categorized into better- and poorer-performing groups, with better-performing survivors scoring no worse than 1.5 standard deviations below the published normative mean on all cognitive measures. Logistic regression was used to identify variables associated with better-performing group membership. RESULTS Approximately 25% of the sample met the criteria for the better-performing group. In unadjusted analyses, RT type (whole brain irradiation and partial brain irradiation), sedating medications, and fatigue were independently associated with cognition. Sociodemographic and other clinical characteristics were not significant. In adjusted analyses, only fatigue remained significantly associated with group membership (OR = 1.05, 95% CI = 1.01-1.09, P = .009). CONCLUSIONS There is a subgroup of survivors with minimal long-term cognitive deficits despite undergoing a full course of brain RT as part of cancer treatment. Lower fatigue had the strongest association with better cognitive performance. Interventions targeting cancer-related fatigue may help buffer the neurotoxic effects of brain RT.
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Affiliation(s)
- Shan S Wong
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - L Douglas Case
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nancy E Avis
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Stephen R Rapp
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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27
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Randazzo DM, McSherry F, Herndon JE, Affronti ML, Lipp ES, Flahiff C, Miller E, Woodring S, Boulton S, Desjardins A, Ashley DM, Friedman HS, Peters KB. Complementary and integrative health interventions and their association with health-related quality of life in the primary brain tumor population. Complement Ther Clin Pract 2019; 36:43-48. [PMID: 31383442 DOI: 10.1016/j.ctcp.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about complementary and integrative health intervention usage in the primary brain tumor population. We aimed to identify the percentage of patients using these practices and explore the impact on quality of life. MATERIALS AND METHODS Clinical records from patients seen in clinic between December 16, 2013 and February 28, 2014 were reviewed retrospectively. The questionnaires used were a modified version of the International Complementary and Alternative Medicine Questionnaire, the Functional Assessment of Cancer Therapy- Brain Cancer and the Functional Assessment of Chronic Illness Therapy- Fatigue. RESULTS 76% of patients utilized a complementary and integrative health modality. The most frequently reported modalities used were vitamins, massage, and spiritual healing, prayer, diet and meditation. CONCLUSION These results confirm the usage of complementary and integrative health practices within the primary brain tumor population; however, there was no evidence of association between use and quality of life.
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Affiliation(s)
- Dina M Randazzo
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Frances McSherry
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC 27710, USA.
| | - James E Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, DUMC Box 2717, Durham, NC, 27710, USA.
| | - Mary L Affronti
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA; Duke University School of Nursing, DUMC 3624, Durham, NC, 27710, USA.
| | - Eric S Lipp
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Charlene Flahiff
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Elizabeth Miller
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Sarah Woodring
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Susan Boulton
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Annick Desjardins
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - David M Ashley
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Henry S Friedman
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
| | - Katherine B Peters
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA.
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28
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Pilot Study to Describe the Trajectory of Symptoms and Adaptive Strategies of Adults Living with Low-grade Glioma. Semin Oncol Nurs 2018; 34:472-485. [PMID: 30409554 DOI: 10.1016/j.soncn.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To describe the adaptability to the patterns in symptoms and quality of life (QoL) during 6 months post low-grade glioma diagnosis by valid and reliable tools; to identify through qualitative interviews patient/provider adaptive techniques and strategies; and to assess associations among patient characteristics, symptoms and QoL, and adaptive techniques or strategies. DATA SOURCES Demographic, clinical and pathologic data from medical records. Validated instruments that assess QoL, fatigue, depression, and distress were completed at 2, 4, and 6 months post diagnosis. Qualitative interviews identifying the symptoms, challenges, adaptive techniques and strategies were conducted at 4 and 6 months. CONCLUSION The most frequently used adaptive strategies included: obtaining community support (87%), managing expectations (73%) and support systems (67%), and seeking out knowledge about physical (67%) and behavioral symptoms (53%). Seizures were reported with IDH1mut (11%) but not IDH1wildtype. Patients with either IDH1mut or TERTmut consistently reported lower QoL and higher distress, depression, and fatigue scores. IDH1/TERTmut may be related to lower QoL because of IDH1mut-related seizures. IMPLICATIONS FOR NURSING PRACTICE Findings provide a list of adaptive strategies and characteristics to address the problems and symptoms that may improve overall QoL in patients with low-grade glioma.
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29
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Handisurya A, Rumpold T, Caucig-Lütgendorf C, Flechl B, Preusser M, Ilhan-Mutlu A, Dieckmann K, Widhalm G, Grisold A, Wöhrer A, Hainfellner J, Ristl R, Kurz C, Marosi C, Gessl A, Hassler M. Are hypothyroidism and hypogonadism clinically relevant in patients with malignant gliomas? A longitudinal trial in patients with glioma. Radiother Oncol 2018; 130:139-148. [PMID: 30389240 DOI: 10.1016/j.radonc.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND So far, the development and course of therapy-induced deficiencies in hypothalamic-pituitary hormones in adult patients with malignant gliomas has not received much attention. However, such deficiencies may impact patient's quality of life substantially. METHODS In this monocentric longitudinal trial, we examined hormonal levels of TSH, T3, T4, fT3, fT4, FSH, LH, testosterone, estradiol and prolactin in patients with malignant high grade gliomas before the start of radiochemotherapy (RCT), at the end of RCT and then every three months for newly diagnosed patients and every six months in patients diagnosed more than two years before study inclusion. Growth hormone was not measured in this trial. RESULTS 436 patients (198 female, 238 male) with high-grade gliomas, aged 19-83 years (median 50 years), were included in this study. Low levels of thyroid hormones were observed in around 10% of patients within the first six months of follow up and increasingly after 36 months. Half of premenopausal women at study entry developed premature menopause, 35% showed hyperprolactinemia. Low testosterone levels were measured in 37% of men aged less than 50 years and in 35/63 (55%) of men aged 50 years or older. DISCUSSION The results of this study show that a significant percentage of patients with malignant gliomas develop hormonal deficiencies mandating regular clinical follow up, state of the art counseling and if clinically necessary substitution therapy.
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Affiliation(s)
- Ammon Handisurya
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Tamara Rumpold
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | | | - Birgit Flechl
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria; Institute of Radiooncology, Kaiser Franz-Josef Spital SMZ-Süd, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University of Vienna, Austria
| | | | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Christine Kurz
- Department of Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
| | - Alois Gessl
- Department of Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Austria
| | - Marco Hassler
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
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Abstract
In the age of ever-expanding treatments and precision medicine, the hope for cure remains the ultimate goal for patients and providers. Equally important to many patients is the quality of life achieved during and after treatment. Evidence suggests that overall quality of life is important to patients and plays a role in determining outcomes in patients with cancer. This article examines components of health-related quality of life and cancer treatment, including physical, psychosocial, and financial burden, as well as how these components affect patients' overall wellbeing and survival.
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Affiliation(s)
- Andrea Sitlinger
- Hematology and Oncology, Duke University Medical Center, 2424 Erwin Road, Suite 602, Room 6046, Durham, NC 27705, USA
| | - Syed Yousuf Zafar
- Duke Cancer Institute, Sanford School of Public Policy, 2424 Erwin Road, Suite 602, Room 6046, Durham, NC 27705, USA.
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31
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Schad F, Thronicke A, Merkle A, Steele ML, Kröz M, Herbstreit C, Matthes H. Implementation of an Integrative Oncological Concept in the Daily Care of a German Certified Breast Cancer Center. Complement Med Res 2018; 25:85-91. [PMID: 29510405 DOI: 10.1159/000478655] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent decades the concept of integrative medicine has attracted growing interest in patients and professionals. At the Gemeinschaftskrankenhaus Havelhöhe (GKH), a hospital specialized in anthroposophical medicine, a breast cancer center (BCC) has been successfully certified for more than 5 years. The objective of the present study was to analyze how integrative strategies were implemented in the daily care of primary breast cancer patients. METHODS Clinical, demographic, and follow-up data as well as information on non-pharmacological interventions were analyzed. In addition, BCC quality measures were compared with data of the National Breast Cancer Benchmarking Report 2016. RESULTS Between 2011 and 2016, 741 primary breast cancer patients (median age 57.4 years) were treated at the GKH BCC. 91.5% of the patients showed Union for International Cancer Control (UICC) stage 0, I, II, or III and 8.2% were in UICC stage IV. 97% of the patients underwent surgery, 53% radiation, 38% had hormone therapy, and 25% received cytostatic drugs. 96% of the patients received non-pharmacological interventions and 32% received Viscum album L. THERAPY Follow-up was performed in up to 93% of the patients 2 years after first diagnosis. Compared to nationwide benchmarking BCCs, the GKH BCC met the requirements in central items. CONCLUSIONS The results of the present study show that integrative therapies offered by the concept of anthroposophical medicine can be implemented in the daily care and treatment of a certified BCC. However, as national guidelines on integrative concepts in oncology are missing, further studies are needed for a systematic evaluation of integrative treatment and care concepts in this field.
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Lillehei KO, Kalkanis SN, Liau LM, Mydland DE, Olson J, Paleologos NA, Ryken T, Johnson T, Scullin E. Rationale and design of the 500-patient, 3-year, and prospective Vigilant ObservatIon of GlIadeL WAfer ImplaNT registry. CNS Oncol 2017; 7:CNS08. [PMID: 29206049 PMCID: PMC5977275 DOI: 10.2217/cns-2017-0036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Implantation of biodegradable wafers impregnated with carmustine (BCNU) is one of the few chemotherapeutic modalities that have been evaluated in Phase III trials and approved by the US FDA for treatment of newly diagnosed high-grade glioma and recurrent glioblastoma. Enrolling up to 500 patients for 3-year follow-up at over 30 sites, the prospective Vigilant ObservatIon of GlIadeL WAfer ImplaNT (VIGILANT) registry (NCT02684838) will evaluate BCNU wafers for treatment of CNS malignancies in contemporary practice and in the new era of molecular tumor analysis. Subgroup analyses will include tumor type, molecular marker status, and treatment combinations. Interim analyses from the VIGILANT registry will be reported until complete results are available in 2024.
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Affiliation(s)
- Kevin O Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Denver, CO, 80045, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, 90095, CA, USA
| | | | - Jeffrey Olson
- Department of Neurosurgery, Emory University, Atlanta, GA, 30322, USA
| | - Nina A Paleologos
- Department of Neurology, Advocate Healthcare, Chicago, IL, 60515, USA
| | - Timothy Ryken
- Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | | | - Evan Scullin
- Arbor Pharmaceuticals, LLC, Atlanta, GA, 30328, USA
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Factors associated with supportive care needs in glioma patients in the neuro-oncological outpatient setting. J Neurooncol 2017; 133:653-662. [PMID: 28527007 DOI: 10.1007/s11060-017-2484-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
Objective of this study aimed at assessing glioma patients' supportive care needs in a neurosurgical outpatient setting and identifying factors that are associated with needs for support. In three neuro-oncological outpatient departments, glioma patients were assessed for their psychosocial needs using the Supportive Care Needs Survey short-form (SCNS-SF34-G). Associations between clinical, sociodemographic, treatment related factors as well as distress (measured with the distress thermometer) and supportive care needs were explored using multivariable general linear models. One-hundred and seventy three of 244 eligible glioma patients participated, most of them with primary diagnoses of a high-grade glioma (81%). Highest need for support was observed in 'psychological needs' (median 17.5, range 5-45) followed by 'physical and daily living needs' (median 12.5, range 0-25) and 'health system and information needs' (median 11.3, range 0-36). Needs in the psychological area were associated with distress (R2 = 0.36) but not with age, sex, Karnofsky performance status (KPS), extend of resection, currently undergoing chemotherapy and whether guidance during assessment was offered. Regarding 'health system and information needs', we observed associations with distress, age, currently undergoing chemotherapy and guidance (R2 = 0.31). In the domain 'physical and daily living needs' we found associations with KPS, residual tumor, as well as with distress (R2 = 0.37). Glioma patients in neuro-oncological departments report unmet supportive care needs, especially in the psychological domain. Distress is the factor most consistently associated with unmet needs requiring support and could serve as indicator for clinical neuro-oncologists to initiate support.
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Tu M, Cai L, Zheng W, Su Z, Chen Y, Qi S. CD164 regulates proliferation and apoptosis by targeting PTEN in human glioma. Mol Med Rep 2017; 15:1713-1721. [PMID: 28259931 PMCID: PMC5364976 DOI: 10.3892/mmr.2017.6204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/22/2016] [Indexed: 12/22/2022] Open
Abstract
Cluster of differentiation 164 (CD164), a sialomucin, has been demonstrated to be involved in the regulation of proliferation, apoptosis, adhesion and differentiation in multiple cancers. CD164 is regarded to be a potential promotor of tumor growth. However, the involvement of CD164 in human glioma proliferation and apoptosis remains unknown. The aim of the present study was to investigate the expression and oncogenic function of CD164 in normal human astrocytes (NHA) and glioma cells in vitro and in vivo. The results of the present study demonstrated that CD164 mRNA and protein levels were significantly increased in human glioma cell lines and tissue samples. CD164 overexpression promoted the proliferation of NHA in vitro, and its tumorigenic effect was confirmed in a murine xenograft model. Knockdown of CD164 inhibited cell proliferation and promoted apoptosis of the U87 human glioma cell line in vitro and in vivo. In addition, knockdown of CD164 was demonstrated to upregulate the Bax/Bcl2 ratio and phosphatase and tensin homolog (PTEN) expression, reduce protein kinase B (AKT) phosphorylation and promote the expression of p53 in U87 cells. The results suggest that CD164 expression may have affected the proliferation and apoptosis of human glioma cells via the PTEN/phosphoinositide 3-kinase/AKT pathway, and may therefore present a potential target for the diagnosis and treatment of glioma.
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Affiliation(s)
- Ming Tu
- Department of Neurosurgery, NanFang Hospital of Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Lin Cai
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Weiming Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhipeng Su
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yong Chen
- Department of Neurosurgery, The Second People's Hospital of Yueyang, Yueyang, Hunan 414000, P.R. China
| | - Songtao Qi
- Department of Neurosurgery, NanFang Hospital of Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Exercise preferences and associations between fitness parameters, physical activity, and quality of life in high-grade glioma patients. Support Care Cancer 2016; 25:1237-1246. [PMID: 27988867 DOI: 10.1007/s00520-016-3516-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE Exercise has numerous benefits for cancer survivors, but very limited research to date has exclusively examined brain cancer patients, specifically those diagnosed with high-grade glioma (HGG). This study examined (1) the feasibility of recruiting HGG patients to an exercise-based study and performing fitness assessments; (2) exercise counseling and programming preferences; and (3) associations between fitness, physical activity (PA), and quality of life (QOL). METHODS Participants completed assessments prior to starting Temozolamide chemotherapy with radiation (T1), at 2 months and 8 months. Fitness was measured with an incremental cycling exercise test to volitional exhaustion (VO2peak) and hand grip dynamometry. The Godin leisure time questionnaire measured PA and the functional assessment for cancer therapy, brain cancer module (FACT-Br) measured QOL. RESULTS Of the 35 approached, N = 16 participated. Due to safety concerns, the aerobic fitness test protocol was altered. Participants preferred to exercise during treatment, alone and unsupervised, at home, and at a moderate intensity. Few participants (<25%) met guidelines for PA at any time point. At T1, aerobic capacity was associated with the FACT Trial Outcome Index (TOI) (r = 0.619, p < 0.05). At 2 months, PA minutes were associated with FACT-TOI (r = 0.653, p = 0.057), FACT-G (r = 0.711, p < 0.05), and FACT-Br scores (r = 0.722, p < 0.05). CONCLUSIONS Recruitment rate was similar to a previous study in HGG populations, but study completion rate was lower. Most exercise counseling and programming preferences were similar to previous brain cancer patients. Assessing aerobic fitness to VO2peak was not feasible. Aerobic fitness and PA were positively associated with QOL.
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36
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Armstrong TS, Bishof AM, Brown PD, Klein M, Taphoorn MJB, Theodore-Oklota C. Determining priority signs and symptoms for use as clinical outcomes assessments in trials including patients with malignant gliomas: Panel 1 Report. Neuro Oncol 2016; 18 Suppl 2:ii1-ii12. [PMID: 26989127 DOI: 10.1093/neuonc/nov267] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patients with primary brain tumors such as malignant gliomas are highly symptomatic, often from the time of diagnosis. Signs and symptoms (signs/symptoms) can cause functional limitations that often worsen over the disease trajectory and may impact patient quality of life. It is recognized that standard measurements of tumor response do not adequately measure this impact or the impact that a therapy may have to mitigate these signs/symptoms and potentially have clinical benefit. Identifying a core set of signs/symptoms and functional limitations is important for understanding their clinical impact and is the first step to including clinical outcomes assessment in primary brain tumor clinical trials.
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Affiliation(s)
- Terri S Armstrong
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Allison M Bishof
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Paul D Brown
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Martin Klein
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Martin J B Taphoorn
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
| | - Christina Theodore-Oklota
- The University of Texas Health Science Center at Houston and MD Anderson Cancer Center, Houston, Texas (T.S.A.); Patient Advocate, Bryn Mawr, Pennsylvania (A.M.B.); The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.); VU University Medical Center, Amsterdam, Netherlands (M.K.); VU University Medical Center, Amsterdam, and Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Genentech, South San Francisco, California (C.T.-O.)
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37
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Boele FW, Given CW, Given BA, Donovan HS, Schulz R, Weimer JM, Drappatz J, Lieberman FS, Sherwood PR. Family caregivers' level of mastery predicts survival of patients with glioblastoma: A preliminary report. Cancer 2016; 123:832-840. [PMID: 27787881 DOI: 10.1002/cncr.30428] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/24/2016] [Accepted: 10/10/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is associated with a poor prognosis, and patients rely heavily on family caregivers for physical and emotional support. The capability and mental health of family caregivers may influence their ability to provide care and affect patient outcomes. The objective of the current study was to investigate whether caregivers' anxiety, depressive symptoms, burden, and mastery influenced survival in a sample of patients newly diagnosed with GBM. METHODS Baseline data from caregiver-patient dyads participating in a longitudinal study funded by the National Institutes of Health were used. Cox regression analyses were performed to determine whether caregiver anxiety (Profile of Mood States-Anxiety), depressive symptoms (Center for Epidemiologic Studies-Depression Scale), burden (Caregiver Reaction Assessment), and feelings of mastery (Mastery Scale) predicted the survival time of patients with GBM after controlling for known covariates (patient age, Karnofsky performance status, type of surgery, and postsurgical treatment). RESULTS A total of 88 caregiver-patient dyads were included. The median overall survival for the sample was 14.5 months (range, 0-88 months). After controlling for covariates, caregiver mastery was found to be predictive of patient survival. With each unit increase in mastery, there was a 16.1% risk reduction in patient death (95% confidence interval, 0.771-0.913; P<.001). CONCLUSIONS To the authors' knowledge, the results of the current study are among the first to explore the impact of family caregiving on the outcomes of patients with GBM. If these results are supported in other studies, providing neuro-oncology caregivers with more structured support and guidance in clinical practice has the potential to improve caregivers' feelings of mastery, thereby influencing patients' well-being for the better. Cancer 2017;123:832-40. © 2016 American Cancer Society.
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Affiliation(s)
- Florien W Boele
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charles W Given
- Department of Family Medicine, Michigan State University, East Lansing, Michigan
| | - Barbara A Given
- College of Nursing, Michigan State University, East Lansing, Michigan
| | - Heidi S Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard Schulz
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason M Weimer
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jan Drappatz
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Frank S Lieberman
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paula R Sherwood
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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Randazzo D, Peters KB. Psychosocial distress and its effects on the health-related quality of life of primary brain tumor patients. CNS Oncol 2016; 5:241-9. [PMID: 27397796 PMCID: PMC6040083 DOI: 10.2217/cns-2016-0010] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/05/2016] [Indexed: 11/21/2022] Open
Abstract
All cancer patients experience distress from the diagnosis, the effects of the disease or the treatment. Clinically significant distress decreases overall quality of life and the recognition of distress with prompt intervention is essential. The National Comprehensive Cancer Network distress thermometer (NCCN-DT) is a validated measuring tool that has been utilized in the primary brain tumor population to detect psychologic distress thereby provoking a referral process to the appropriate support system. Brain tumor patients commonly reported emotional and physical distress encompassing: fatigue, fears, memory and concentration and worry. More research is needed to identify the stressors of all primary brain tumor patients and their caretakers and integrate appropriate interventions to improve health-related quality of life in both groups.
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Affiliation(s)
- Dina Randazzo
- Department of Neurology, Duke University Medical Center, The Preston Robert Tisch Brain Tumor Center, Durham, NC 27710, USA
| | - Katherine B Peters
- Department of Neurology, Duke University Medical Center, The Preston Robert Tisch Brain Tumor Center, Durham, NC 27710, USA
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Bayen E, Laigle-Donadey F, Prouté M, Hoang-Xuan K, Joël ME, Delattre JY. The multidimensional burden of informal caregivers in primary malignant brain tumor. Support Care Cancer 2016; 25:245-253. [PMID: 27624465 DOI: 10.1007/s00520-016-3397-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Informal caregivers (ICs) provide care and improve the quality of life of patients with malignant brain tumor. We analyze the impact of their involvement on themselves from a triple perspective. METHODS Home-dwelling patients with primary malignant brain tumor underwent a medical examination. ICs burden was evaluated by a self-administered postal questionnaire. Objective burden (Informal Care Time, ICT), subjective burden (Zarit Burden Inventory, ZBI), and financial burden (valuation of lost earnings using the Replacement and Opportunity Cost Methods, RCM, OCM) were evaluated. RESULTS ICs (N = 84) were principally women (87 %) and spouses (64 %), of mean age 55 years, who assisted patients of mean age 53 years and with a mean KPS score of 61 (range = 30-90, med = 60). Subjective burden was moderate (mean ZBI = 30). Objective burden was high (mean ICT = 11.7 h/day), mostly consisting of supervision time. Higher subjective and objective burden were associated with poorer functional status (KPS) but not with a higher level of cognitive disorders in multivariate analyses. Other independent associated factors were bladder dysfunction and co-residency for objective burden and working and a poor social network for subjective burden. The 56 working ICs made work arrangements (75 %) that impacted their wages (36 %) and careers (30 %). Financial burden due to uncompensated caregiving hours for Activities of Daily Living had a mean monetary value from Є677(RCM) to Є1683(OCM) per month (i.e., ranging from Є8124 to Є20196 per year). CONCLUSIONS IC burden is multidimensional. Greater provision of formal care, more IC support programs, and economic interventions targeting IC employment and finances are needed.
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Affiliation(s)
- Eléonore Bayen
- Department of Neuro-Rehabilitation, Pitié-Salpêtrière Hospital, Paris, France. .,Health Economics Department LEDa-LEGOS, PSL University Paris-Dauphine, Paris, France.
| | | | - Myrtille Prouté
- Health Economics Department LEDa-LEGOS, PSL University Paris-Dauphine, Paris, France
| | - Khê Hoang-Xuan
- Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University UPMC Paris 06, CRICM, Paris, France.,INSERM U1127, Paris, France.,CNRS, UMR 7225, Paris, France
| | - Marie-Eve Joël
- Health Economics Department LEDa-LEGOS, PSL University Paris-Dauphine, Paris, France
| | - Jean-Yves Delattre
- Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University UPMC Paris 06, CRICM, Paris, France.,INSERM U1127, Paris, France.,CNRS, UMR 7225, Paris, France
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40
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Asher A, Fu JB, Bailey C, Hughes JK. Fatigue among patients with brain tumors. CNS Oncol 2016; 5:91-100. [PMID: 26987038 PMCID: PMC6047436 DOI: 10.2217/cns-2015-0008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
Abstract
Fatigue is a ubiquitous and an extremely distressing symptom among patients with brain tumors (BT), particularly those with high-grade gliomas. The pathophysiology of cancer-related fatigue (CRF) in the context of patients with BT is multifactorial and complex, involving biological, behavioral, medical and social factors. The etiology of CRF in the general oncology population is pointing to the role of inflammatory cytokines as a key factor in the genesis of CRF, but this research is currently limited in the setting of BT. CRF should be screened, assessed and managed according to clinical practice guidelines. Fatigue has recently emerged as a strong, independent prognostic factor for survival that provides incremental prognostic value to the traditional markers of prognosis in recurrent high-grade gliomas. Therefore, strategies to treat fatigue warrant investigation, not only to improve the QOL of a group of patients with often limited life expectancy, but also possibly to optimize survival.
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Affiliation(s)
- Arash Asher
- Cancer Survivorship & Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Assistant Clinical Professor, Health Sciences, UCLA, 8700 Beverly Boulevard, AC 1109 Los Angeles, 90048, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030, USA
| | - Charlotte Bailey
- Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Jennifer K Hughes
- Department of Rehabilitation, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Abstract
Disabling sequelae occur in a majority of patients diagnosed with brain tumor, including glioma, such as cognitive deficits, weakness, and visual perceptual changes. Often, multiple impairments are present concurrently. Healthcare staff must be aware of the "biographic disruption" the patient with glioma has experienced. While prognostic considerations factor into rehabilitation goals and expectations, regardless of prognosis the treatment team must offer cohesive support, facilitating hope, function, and quality of life. Awareness of family and caregiver concerns plays an important role in the overall care. Inpatient rehabilitation, especially after surgical resection, has been shown to result in functional improvement and homegoing rates on a par with individuals with other neurologic conditions, such as stroke or traumatic brain injury. Community integration comprises a significant element of life satisfaction, as has been shown in childhood glioma survivors. Employment is often affected by the glioma diagnosis, but may be ameliorated, when appropriate, by addressing modifiable factors such as depression, fatigue, or sleep disturbance, or by workplace accommodations. Further research is needed into many facets of rehabilitation in the setting of glioma, including establishing better care models for consistently identifying and addressing functional limitations in this population, measuring outcomes of various levels of rehabilitation care, identifying optimal physical activity strategies, delineating the long-term effects of rehabilitation interventions, and exploring impact of rehabilitation interventions on caregiver burden. The effective elements of cognitive rehabilitation, including transition of cognitive strategies to everyday living, need to be better defined.
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Affiliation(s)
- Mary Vargo
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
| | | | - Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden
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42
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Management of Gliomas: Overview of the Latest Technological Advancements and Related Behavioral Drawbacks. Behav Neurol 2015; 2015:862634. [PMID: 26346755 PMCID: PMC4546744 DOI: 10.1155/2015/862634] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/26/2015] [Indexed: 01/22/2023] Open
Abstract
The advancements in basic sciences and the availability of sophisticated technological aids to surgical removal of gliomas have led over the last few years to the rise of innovative surgical strategies, the identification of better prognostic/predictive biomolecular factors, and the development of novel drugs and all are meant to profoundly impact the outcome of patients diagnosed with these aggressive tumours. Unfortunately, the treatment protocols available nowadays still confer only a small survival advantage at a potentially high cost in terms of overall well-being. In this review we identified the potential and limits of the most promising research trends in the management of glioma patients, also highlighting the related externalities. Finally, we focused our attention on the imbalance between the technical and behavioral aspects pertinent to this research area, which ultimately represent the two sides of the same coin.
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Bossola M, Di Stasio E, Antocicco M, Panico L, Pepe G, Tazza L. Fatigue Is Associated with Increased Risk of Mortality in Patients on Chronic Hemodialysis. Nephron Clin Pract 2015; 130:113-8. [DOI: 10.1159/000430827] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
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44
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Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Gynecol Oncol 2014; 136:446-52. [PMID: 25458588 DOI: 10.1016/j.ygyno.2014.10.013] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/07/2014] [Accepted: 10/11/2014] [Indexed: 12/18/2022]
Abstract
Fatigue is a distressing and persistent symptom for patients with gynecological cancer and for survivors. Debilitating cancer-related fatigue (CRF) is produced by both the disease and its treatment. Although awareness and study of CRF have grown in recent years, consistent assessment has not been a priority in routine medical practice. The pathophysiological mechanisms that induce CRF remain unclear, and effective pharmacological interventions have yet to be established. Based on the literature and our own research results, this review focuses on recent progress toward understanding the nature and causes of CRF and on several promising treatment modalities. Given the prevalence and severity of CRF in the gynecological cancer patient population, establishing standardized fatigue measurement and management methods in routine clinical oncology care is of utmost importance. Whether CRF has an underlying inflammatory cause is still hypothetical, however, and no mechanism-driven symptom intervention is currently in clinical use, even though the development of such interventions would provide patients with greater symptom control. Advancing translational and clinical fatigue research will require anatomical pathway studies and well-designed clinical investigations that focus on the development of mechanism-driven interventions based on physiological-behavioral fatigue research, implementation of guidelines for experimental designs, and discovery of biomarkers identifying individuals at high risk for CRF. Validated patient-reported outcomes measures are an essential component of such clinical studies. Because numerous subscales, unidimensional measures, and multidimensional measures exist, clinicians and researchers should consider individual circumstances, good clinical practice, and research goals as guides for choosing the most appropriate fatigue measurement tool. Additionally, education about CRF should be made available to all patients and their caregivers, as accurate and age-appropriate information about conditions like CRF can alleviate much of the stress and anxiety brought on by poor communication about this distressing condition.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jeanie F Woodruff
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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