Experiences of language and communication after brain-tumour treatment: A long-term follow-up after glioma surgery

Subjective, but not objective, language functions predict fatigue in patients with lower-grade gliomas during longitudinal follow-up

PURPOSE

To investigate the course of fatigue, subjective and objective language functions in patients with lower-grade gliomas during the first year of disease. Further, to examine if subjective and objective language variables predicted ratings of fatigue.

METHODS

Fatigue was assessed with the Fatigue Severity Scale, subjective language with self-reported word-finding, expression of thoughts, reading and writing from the Functional Assessment of Cancer Therapy - Brain, and objective language with standardized tests. Mixed models were used to investigate changes in variables over time and predictors of fatigue.

RESULTS

Twenty-three patients with gliomas (WHO 1-3) were included. Average ratings of fatigue did not change significantly, but altering patterns were observed. Subjective concerns about word-finding and expression of thoughts increased significantly during follow-up. The regression analyses showed that concerns about abilities to read and write significantly predicted fatigue. The results indicated that less concerns about reading and writing were associated with lower levels of fatigue.

CONCLUSIONS

Patients with lower-grade gliomas report fatigue and language concerns throughout the first year. Concerns about reading and writing call for careful consideration as they seem to provoke fatigue. The findings underline the importance of the patients' perspective in treatment and follow-up.

Glioblastoma Cell Migration, Invasion and Vasculogenic Mimicry Downmodulated by Novel uPAcyclin Derivatives

Despite extensive efforts to develop new treatments, the prognosis for glioblastoma multiforme (GBM) is extremely unfavorable, urging the identification of new chemotherapeutics. A previous work identified the cyclic decapeptide uPAcyclin as a potent inhibitor of GBM cell migration, matrix invasion and vascular-like structures' formation, acting through binding to αV integrins and not interfering with cell proliferation or survival. These clearcut activities prompted us to design and test novel derivatives on cultured U87-MG and U251 GBM-MG human cells. With the exception of the residues involved in peptide cyclization, residues were Ala-substituted one by one and the single peptides tested for binding affinity for the αV target integrin, the inhibition of migration, invasion and vasculogenic mimicry. The first screening highlighted peptides with a low binding affinity and low inhibitory ability (Ala4,7,9 derivatives) and peptides with affinity and inhibitory capacity higher than uPAcyclin (Ala2,5,6,8 derivatives). The integration of these results with conformational studies led to the design of the di-substituted variant uPAcyclin. Intriguingly, at least ten-fold greater anti-migratory and anti-invasive effects of the [Ala2,Ala5]uPAcyclin variant compared to uPAcyclin were found. The latter variant also exhibited a greater inhibitory potential for vascular-like structures' formation by matrix-seeded GBM cells. These studies shed light on the functional relevance of single amino acid residues in uPAcyclin and lead to the identification of therapeutically interesting new variants as promising candidates for anti-GBM therapies.

The Impact of Brain Tumors on Emotional and Behavioral Functioning

While the physical manifestations of brain tumors are well-documented, their impact on the emotional and psychological landscape of patients is of equal importance. Patients frequently experience a range of challenges from depression, apathy, and increased aggression to personality changes. The complexity of these changes and their effects on emotional functioning are shaped by tumor characteristics, including location, growth rate, and the corresponding hormonal imbalances. These challenges may ripple outward, affecting not only the patients themselves but also their caregivers. This review aims to examine the diverse emotional experiences associated with various brain tumor types and locations, through understanding the neurobiological mechanisms underlying these changes. The impact of psychosocial factors on emotional distress and coping strategies is also explored, focusing on the critical role of social support and resilience. The need for integrated care that addresses both the physical and psychological aspects of brain tumors is essential for improving the quality of life (QoL) for patients and their families. The close relationship between emotional and cognitive difficulties is analyzed, stressing how these challenges can mutually reinforce each other, creating a convoluted and challenging situation for brain tumor patients. By understanding and addressing these issues, healthcare providers can better support patients and improve their overall QoL. This review seeks to consolidate the current understanding of this complicated relationship, drawing from an array of studies, reviews, and meta-analyses.

Enhancing Glioblastoma Resection with NIR Fluorescence Imaging: A Systematic Review

Glioblastoma (GB) is among the most aggressive and difficult-to-treat brain tumors, with a median survival of only 12-15 months despite maximal treatments, including surgery, radiotherapy, and chemotherapy. Extensive surgical resection improves survival in glioblastoma patients; however, achieving complete resection is often hindered by limitations in neurosurgical guidance technologies for accurate tumor margin detection. Recent advancements in fluorescence-guided surgery (FGS) and imaging techniques have significantly enhanced the precision and extent of glioblastoma resections. This study evaluates the impact of NIR fluorescence imaging on tumor visualization, surgical precision, cost-effectiveness, and patient survival. A systematic review of PubMed, Scopus, Google Scholar, and Embase was conducted to identify studies on the role of NIR fluorescence in glioblastoma surgery. A total of 135 studies were included, comprising 10 reviews, three clinical studies, 10 randomized controlled trials (RCTs), 10 preclinical studies, and four case reports, all focused on NIR fluorescence imaging in glioblastoma surgery. The findings indicate that NIR fluorescence imaging significantly improves tumor visualization, resulting in an 18-22% increase in gross total resection (GTR) rates in clinical studies. NIR fluorescence provides continuous real-time feedback, minimizing repeat imaging, reducing operational costs, and increasing GTR. These improvements contribute to better patient outcomes, including extended progression-free survival, improved overall survival, and reduced postoperative neurological deficits. This review underscores the potential of NIR imaging to establish a new standard for intraoperative glioblastoma management.

Preoperative subjective impairments in language and memory in brain tumor patients

Background

Subjective reports can reveal relevant information regarding the nature of the impairment of brain tumor patients, unveiling potential gaps in current assessment practices. The co-occurrence of language and memory impairments has been previously reported, albeit scarcely. The aim of this study is therefore to understand the co-occurrence of subjective language and memory complaints in the preoperative state of brain tumor patients and its impact on Quality of Life (QoL).

Methods

31 brain tumor patients (12 LGG, 19 HGG) underwent a semi-structured interview to assess subjective complaints of language deficits, co-occurrences between language and memory dysfunction, and changes in QoL. Group and subgroup analyses were conducted to provide general and tumor grade specific data.

Results

48.4% of patients mentioned co-occurrence of language and memory impairments in reading, writing, and conversation. The HGG group reported co-occurrences in all three of these (reading: 31.6%; writing: 21.1%; conversation: 26.3%), while the LGG only described co-occurrences in reading (25%) and conversation (8.3%), although these were not statistically significant. All patients with co-occurring language and memory deficits reported these to be linked to reduced QoL (48.4%). In patients with an HGG, this number was slightly higher (52.6%) than in patients with an LGG (41.7%).

Conclusion

Language impairments co-occur with memory dysfunction as perceived in patients' daily life. Patients see these impairments as affecting their quality of life. Further attention to dedicated language and memory tasks seems necessary.

"It changes everything": Understanding how people experience the impact of living with a lower-grade glioma

Background

Quantitative studies show people living with a lower-grade glioma (LGG) often report low health-related quality of life. However, it is unclear how this impact is experienced; resulting supportive care needs are also poorly understood. We explored how people experience the impact of living long-term with an LGG, to help identify potential supportive care needs.

Methods

We conducted semi-structured interviews with a diverse group of people with LGG (n = 28) across the United Kingdom, who had completed primary treatment (male n = 16, female n = 12, mean age 54.6 years, mean time since diagnosis 8.7 years). Interviews were transcribed and inductive thematic analysis was conducted.

Results

Four themes relating to the impact experiences of people with LGG were generated: "Emotional response to the diagnosis," "Living with the 'What ifs'," "Changing relationships," and "Faltering independence." These reflect participants' experiences with symptoms (eg, fatigue, seizures) and impairments (eg, motor dysfunction, cognitive deficits), and how these, in turn, drive impacts on daily living (including on work, relationships, social activities, and transport). Participants spoke about their experiences with profound emotion throughout.

Conclusions

People with LGG can experience wide-ranging everyday impacts and may have extensive supportive care needs. This study highlights how this impact is experienced and what it means to people with LGG. Best practice suggestions for conducting comprehensive needs assessments tailored to those with LGG, and the development of personalized plans to meet those needs, would be a critical step to ensure that people with LGG are best supported in living with their condition.

Disfluencies in spontaneous speech in persons with low-grade glioma before and after surgery

Impaired lexical retrieval is common in persons with low-grade glioma (LGG). Several studies have reported a discrepancy between subjective word-finding difficulties and results on formal tests. Analysis of spontaneous speech might be more sensitive to signs of word-finding difficulties, hence we aimed to explore disfluencies in a spontaneous-speech task performed by participants with presumed LGG before and after surgery. Further, we wanted to explore how the presence of disfluencies in spontaneous speech differed in the participants with and without objectively established lexical-retrieval impairment and with and without self-reported subjective experience of impaired language, speech and communication. Speech samples of 26 persons with presumed low-grade glioma were analysed with regard to disfluency features. The post-operative speech samples had a higher occurrence of fillers, implying more disfluent language production. The participants performed worse on two of the word fluency tests, and after surgery the number of participants who were assessed as having an impaired lexical retrieval had increased from 6 to 12. The number of participants who experienced a change in their language, speech or communication had increased from 9 to 12. Additional comparisons showed that those with impaired lexical retrieval had a higher proportion of false starts after surgery than those with normal lexical retrieval, and differences in articulation rate and speech rate, favouring those not having experienced any change in language, speech or communication. Taken together, the findings from this study strengthen the existing claim that temporal aspects of language and speech are important when assessing persons with gliomas.