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Zanotto A, Glover RN, Zanotto T, Boele FW. Rehabilitation in People Living with Glioblastoma: A Narrative Review of the Literature. Cancers (Basel) 2024; 16:1699. [PMID: 38730651 PMCID: PMC11083409 DOI: 10.3390/cancers16091699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Glioblastoma is the most common primary malignant brain tumor. While preliminary data point to the positive effects of rehabilitation for patients with glioblastoma, there are unique challenges for clinicians working with this population, including limited life expectancy and/or rapid neurological deterioration. The aim of this article is to review the literature on rehabilitation of adults with glioblastoma, including the feasibility of interventions, their effectiveness, as well as the current clinical practice. The reviewed literature suggests that rehabilitation has been found beneficial for improving the functional prognosis and quality of life of adults with glioblastoma and is desired by patients. We summarize the qualitative evidence regarding healthcare professionals' and patients' perspectives on the use of supportive care services. We conclude there is a need for the design of effective rehabilitation programs for patients with glioblastoma, as well as for the development of glioblastoma-specific clinical guidelines for rehabilitation practitioners.
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Affiliation(s)
- Anna Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; (R.N.G.); (T.Z.)
| | - Rebecca N. Glover
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; (R.N.G.); (T.Z.)
| | - Tobia Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; (R.N.G.); (T.Z.)
| | - Florien W. Boele
- Patient Centred Outcomes Research Group, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds LS2 9JT, UK
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
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Piil K, Boele F. Paving the way to evidence-based clinical practice: Establishing effective caregiver and family support interventions. Neurooncol Pract 2023; 10:504-505. [PMID: 38009121 PMCID: PMC10666806 DOI: 10.1093/nop/npad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Affiliation(s)
- Karin Piil
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Florien Boele
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, United Kingdom
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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Lenffer B, Ruben J, Senthi S, Millar J, Ong WL. Management and outcomes of glioblastoma: 20-year experience in a single Australian institution. J Med Imaging Radiat Oncol 2023. [PMID: 37997616 DOI: 10.1111/1754-9485.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION We aimed to evaluate the changing patterns in the management of glioblastoma (GBM) and impact on survival outcomes over a 20-year period. METHODS This is a retrospective study of patients diagnosed with GBM between 2001 and 2020, who had radiation therapy (RT) in an Australian institution. The primary outcomes were changes in treatment modalities (including surgery, RT, and chemotherapy) over time and overall survival (OS). Multivariable Cox regressions were used to evaluate factors associated with OS, including age, sex, ECOG performance status, treatment modalities, treatment facility, and year of treatment. RESULTS 1079 patients were included in this study. Thirty-five per cent of patients had gross total resection, increasing from 31% in 2001-2005 to 45% in 2016-2020 (P < 0.001). Sixty-four per cent of patients had ≥60 Gy RT, increasing from 57% in 2001-2005 to 66% in 2016-2020 (P < 0.001). Seventy-five per cent of patients had chemotherapy, increasing from 22% in 2001-2005 to 89% in 2016-2020 (P < 0.001). Treatment received varied based on patients' age and ECOG performance status. The median OS for the entire cohort was 13.0 months (95% CI = 12.0-13.7). Median OS in patients who had maximal treatment (i.e., gross total resection, ≥60 Gy RT and chemotherapy) was 20.6 months (95% CI = 17.3-22.8). In multivariable analyses, age, sex, treatment facility, extent of surgical resection, RT dose, and chemotherapy use were associated with OS. CONCLUSION This is one of the largest Australian series on the management and outcomes of GBM spanning a 20-year period. We observed improvement in OS over time, which is likely associated with evolving treatment options over the study period.
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Affiliation(s)
- Bianca Lenffer
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
| | - Jeremy Ruben
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Young JS, Al-Adli N, Sibih YE, Scotford KL, Casey M, James S, Berger MS. Recognizing the psychological impact of a glioma diagnosis on mental and behavioral health: a systematic review of what neurosurgeons need to know. J Neurosurg 2023; 139:11-19. [PMID: 36334288 PMCID: PMC10413205 DOI: 10.3171/2022.9.jns221139] [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: 05/12/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
A cancer diagnosis is life altering and frequently associated with both acute and long-lasting psychosocial and behavioral distress for patients. The impact of a diffuse glioma diagnosis on mental health is an important aspect of the patient experience with their disease. This needs to be understood by neurosurgeons so these concerns can be appropriately addressed in a timely fashion and integrated into the multidisciplinary care of neuro-oncology patients. The relatively grave prognosis associated with diffuse gliomas, the morbidity associated with treatment, and the constant threat of developing a new neurological deficit all can negatively affect a patient's mental ability to cope and ultimately manifest in mental health disorders such as anxiety and depression. The objective of this systematic review was to describe the variety of behavioral health disorders patients may experience following a glioma diagnosis and discuss possible treatment options. The PubMed, Web of Science, Embase, and PsycINFO databases were searched through July 1, 2022, using broad search terms, which resulted in 5028 studies that were uploaded to Covidence systematic review software. Duplicates, non-English-language studies, and studies with irrelevant outcomes or incorrect design were removed (n = 3167). A total of 92 articles reporting behavioral health outcomes in brain tumor patients were categorized and extracted for associations with overall mental health, anxiety, depression, distress, stress, pharmacology, interventions, and mental health in caregivers. The authors identified numerous studies reporting the prevalence of mental health disorders and their negative influence in this population. However, there is a paucity of literature on therapeutic options for patients. Given the strong correlation between patient quality of life and mental well-being, there is a considerable need for early recognition and treatment of these behavioral health disorders to optimize everyday functioning for patients.
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Affiliation(s)
- Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Nadeem Al-Adli
- Department of Neurological Surgery, University of California, San Francisco, CA
- School of Medicine, Texas Christian University, Fort Worth, TX
| | - Youssef E. Sibih
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Katrina L. Scotford
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Megan Casey
- School of Medicine, University of California, San Francisco, CA
| | | | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, CA
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Halkett GKB, Lobb EA, Phillips JL, McDougall E, Clarke J, Campbell R, Dhillon HM, McGeechan K, Hudson P, King A, Wheeler H, Kastelan M, Long A, Nowak AK. Carer preparedness improved by providing a supportive educational intervention for carers of patients with high-grade glioma: RCT results. J Neurooncol 2023; 161:501-513. [PMID: 36658381 PMCID: PMC9992082 DOI: 10.1007/s11060-023-04239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND High-grade glioma (HGG) is a rapidly progressing and debilitating disease. Family carers take on multiple responsibilities and experience high levels of distress. We aimed to deliver a nurse-led intervention (Care-IS) to carers to improve their preparedness to care and reduce distress. METHODS We conducted a randomised controlled trial (ACTRN:12612001147875). Carers of HGG patients were recruited during patients' combined chemoradiation treatment. The complex intervention comprised four components: (1) initial telephone assessment of carer unmet needs; (2) tailored hard-copy resource folder; (3) home visit; and, (4) monthly telephone support for up to 12 months. Primary outcomes included preparedness for caregiving and distress at 2, 4, 6 and 12 months. Intervention effects were estimated using linear mixed models which included a time by group interaction. Secondary outcomes included anxiety, depression, quality of life, carer competence and strain. RESULTS We randomised 188 carers (n = 98 intervention, n = 90 control). The intervention group reported significantly higher preparedness for caregiving at 4 months (model β = 2.85, 95% CI 0.76-4.93) and all follow-up timepoints including 12 months (model β = 4.35, 95% CI 2.08-6.62), compared to the control group. However, there was no difference between groups in carer distress or any secondary outcomes. CONCLUSIONS This intervention was effective in improving carer preparedness. However, carer distress was not reduced, potentially due to the debilitating/progressive nature of HGG and ongoing caring responsibilities. Future research must explore whether carer interventions can improve carer adjustment, self-efficacy and coping and how we support carers after bereavement. Additionally, research is needed to determine how to implement carer support into practice.
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Affiliation(s)
- Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Sydney, NSW, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Emma McDougall
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Jenny Clarke
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6005, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia.,Vrije University Brussels, Brussels, Belgium
| | - Anne King
- Cancer Network Western Australia, North Metropolitan Health Service, Perth, WA, Australia
| | - Helen Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia
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Determining the Research Priorities for Adult Primary Brain Tumours in Australia and New Zealand: A Delphi Study with Consumers, Health Professionals, and Researchers. Curr Oncol 2022; 29:9928-9955. [PMID: 36547195 PMCID: PMC9777470 DOI: 10.3390/curroncol29120781] [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: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas.
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