Abstract
The association between health-related quality of life (HRQoL), psychosocial distress, and supportive care is in the focus of patient-centered neuro-oncology. We investigated the relationship between the aforementioned in glioma-patients to evaluate the association of these instruments and determine cut-off values for suitable HRQoL scales indicating a potential need for intervention. In an observational multi-center study, outpatients completed the Distress Thermometer (DT), EORTC Quality of Life Questionnaire (EORTC-QLQ-C30/BN20, HRQoL), and Supportive-Care-Needs-Survey-SF34-G (SCNS). Based on nine EORTC-function and selected -symptom scales items of the questionnaires were matched. Convergent validity of related single items and scores across the instruments was estimated. EORTC cut-off values were calculated. Data of 167 patients were analyzed. The strongest correlation of EORTC-QLQ-C30 and DT was found for cognitive function (cogf), global health status (GHS), emotional (emof), role function (rolef), future uncertainty (FU), fatigue, and between EORTC-QLQ-C30 and SCNS for FU, emof, rolef (r = |0.4–0.7|; p < 0.01). EORTC cut-off values of <54.2 (GHS/QoL) and <62.5 (emof) predicted a DT ≥ 6 (AUC 0.79, 0.85, p < 0.01). EORTC cut-off values of <70.8 (emof) and <52.8 (FU) predicted the need for supportive care (AUC 0.78, 0.85; p < 0.01). Worse EORTC-C30 scores correlate with higher DT and SCNS scores. With this exploratory assessment, cut-off values for EORTC-C30 subscores to predict distress and pathological SCNS-scores could be determined, which could influence patients’ referral to further treatment. However, further prospective clinical trials are needed to confirm the clinical relevance of these cut-off values.
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References
Chan CM, Wan Ahmad WA, Md Yusof M, Ho GF, Krupat E (2014) Effects of depression and anxiety on mortality in a mixed cancer group: a longitudinal approach using standardised diagnostic interviews. Psychooncology. doi:10.1002/pon.3714
Singer S, Szalai C, Briest S, Brown A, Dietz A, Einenkel J, Jonas S, Konnopka A, Papsdorf K, Langanke D, Lobner M, Schiefke F, Stolzenburg JU, Weimann A, Wirtz H, Konig HH, Riedel-Heller S (2013) Co-morbid mental health conditions in cancer patients at working age -prevalence, risk profiles, and care uptake. Psychooncology. doi:10.1002/pon.3282
Pinquart M, Duberstein PR (2010) Depression and cancer mortality: a meta-analysis. Psychol Med 40(11):1797–1810. doi:10.1017/S0033291709992285
Satin JR, Linden W, Phillips MJ (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 115(22):5349–5361. doi:10.1002/cncr.24561
Kissane D (2009) Beyond the psychotherapy and survival debate: the challenge of social disparity, depression and treatment adherence in psychosocial cancer care. Psychooncology 18(1):1–5. doi:10.1002/pon.1493
Prieto JM, Atala J, Blanch J, Carreras E, Rovira M, Cirera E, Espinal A, Gasto C (2005) Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation. J Clin Oncol 23(25):6063–6071. doi:10.1200/JCO.2005.05.751
Lamborn KR, Chang SM, Prados MD (2004) Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro-oncol 6(3):227–235. doi:10.1215/S1152851703000620
Polley MY, Lamborn KR, Chang SM, Butowski N, Clarke JL, Prados M (2011) Conditional probability of survival in patients with newly diagnosed glioblastoma. J Clin Oncol 29(31):4175–4180. doi:10.1200/JCO.2010.32.4343
Mainio A, Tuunanen S, Hakko H, Niemela A, Koivukangas J, Rasanen P (2006) Decreased quality of life and depression as predictors for shorter survival among patients with low-grade gliomas: a follow-up from 1990 to 2003. Eur Arch Psychiatry Clin Neurosci 256(8):516–521. doi:10.1007/s00406-006-0674-2
Mauer M, Stupp R, Taphoorn MJ, Coens C, Osoba D, Marosi C, Wong R, de Witte O, Cairncross JG, Efficace F, Mirimanoff RO, Forsyth P, van den Bent MJ, Weller M, Bottomley A (2007) The prognostic value of health-related quality-of-life data in predicting survival in glioblastoma cancer patients: results from an international randomised phase III EORTC Brain Tumour and Radiation Oncology Groups, and NCIC Clinical Trials Group study. Br J Cancer 97(3):302–307. doi:10.1038/sj.bjc.6603876
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376
Osoba D, Aaronson NK, Muller M, Sneeuw K, Hsu MA, Yung WK, Brada M, Newlands E (1996) The development and psychometric validation of a brain cancer quality-of-life questionnaire for use in combination with general cancer-specific questionnaires. Qual Life Res 5(1):139–150
Group EQoL (2002) Guidelines for assessing quality of life in EORTC clinical trials
Snyder CF, Garrett-Mayer E, Blackford AL, Brahmer JR, Carducci MA, Pili R, Stearns V, Wolff AC, Dy SM, Wu AW (2009) Concordance of cancer patients’ function, symptoms, and supportive care needs. Qual Life Res 18(8):991–998. doi:10.1007/s11136-009-9519-6
Snyder CF, Garrett-Mayer E, Brahmer JR, Carducci MA, Pili R, Stearns V, Wolff AC, Dy SM, Wu AW (2008) Symptoms, supportive care needs, and function in cancer patients: how are they related? Qual Life Res 17(5):665–677. doi:10.1007/s11136-008-9331-8
Maringwa J, Quinten C, King M, Ringash J, Osoba D, Coens C, Martinelli F, Reeve BB, Gotay C, Greimel E, Flechtner H, Cleeland CS, Schmucker-Von Koch J, Weis J, Van Den Bent MJ, Stupp R, Taphoorn MJ, Bottomley A, Project and Brain Cancer Group (2011) Minimal clinically meaningful differences for the EORTC QLQ-C30 and EORTC QLQ-BN20 scales in brain cancer patients. Ann Oncol 22 (9):2107–2112. doi:10.1093/annonc/mdq726
Kvale EA, Murthy R, Taylor R, Lee JY, Nabors LB (2009) Distress and quality of life in primary high-grade brain tumor patients. Support Care Cancer 17(7):793–799. doi:10.1007/s00520-008-0551-9
Goebel S, Strenge H, Mehdorn HM (2012) Acute stress in patients with brain cancer during primary care. Support Care Cancer 20(7):1425–1434. doi:10.1007/s00520-011-1225-6
Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E (2007) Quality of life among patients with a brain tumor and their carers. J Psychosom Res 63(6):617–623. doi:10.1016/j.jpsychores.2007.06.018
Mehnert Anja MD, Lehmann Claudia, Koch UWe (2006) The German version of the NCCN distress thermometer: validation of a screening instrument for assessment of psychosocial distress in cancer patients. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 54 (3):213–223. doi:10.1024/1661-4747.54.3.213
Goebel S, Mehdorn HM (2011) Measurement of psychological distress in patients with intracranial tumours: the NCCN distress thermometer. J Neurooncol 104(1):357–364. doi:10.1007/s11060-010-0501-5
Boyes A, Girgis A, Lecathelinais C (2009) Brief assessment of adult cancer patients’ perceived needs: development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34). J Eval Clin Pract 15(4):602–606. doi:10.1111/j.1365-2753.2008.01057.x
Wen KY, Gustafson DH (2004) Needs assessment for cancer patients and their families. Health Qual Life Outcomes 2:11. doi:10.1186/1477-7525-2-11
Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK (1993) The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life. Qual Life Res 2(4):287–295
Taphoorn MJ, Claassens L, Aaronson NK, Coens C, Mauer M, Osoba D, Stupp R, Mirimanoff RO, van den Bent MJ, Bottomley A, Group EQoL, Brain Cancer NCIC, Radiotherapy Group (2010) An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients. Eur J Cancer 46 (6):1033–1040. doi:10.1016/j.ejca.2010.01.012
National Comprehensive Cancer Network (2003) Distress management. Clinical practice guidelines. J Natl Compr Canc Netw 1(3):344–374
Bonevski B, Sanson-Fisher R, Girgis A, Burton L, Cook P, Boyes A (2000) Evaluation of an instrument to assess the needs of patients with cancer. Supportive Care Review Group. Cancer 88(1):217–225
Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer 88(1):226–237
Lehmann C, Koch U, Mehnert A (2012) Psychometric properties of the German version of the short-form supportive care needs survey questionnaire (SCNS-SF34-G). Support Care Cancer 20(10):2415–2424. doi:10.1007/s00520-011-1351-1
McElduff Patrick BA, Zucca A, Girgis A (2004) Supportive care needs survey: a guide to administration, scoring and analysis. Centre Health Res Psychooncol (CHeRP)
Cormie P, Nowak AK, Chambers SK, Galvao DA, Newton RU (2015) The potential role of exercise in neuro-oncology. Front Oncol 5:85. doi:10.3389/fonc.2015.00085
Langbecker D, Yates P (2015) Primary brain tumor patients’ supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: awareness, referral and utilization. J Neurooncol. doi:10.1007/s11060-015-2013-9
Taylor R (1990) Interpretation of the correlation coefficient: a basic review. J Diagnos Med Sonograp 6(1):35–39. doi:10.1177/875647939000600106
Cohen J (1988) Statistical Power analysis for the behavioral sciences. 2nd edn. Lawrence Erlenbaum Associates Publishers, Hillsdale
Youden WJ (1950) Index for rating diagnostic tests. Cancer 3(1):32–35
Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96(5):644–647. doi:10.1111/j.1651-2227.2006.00178.x
Scott NW, Fayers PM, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Sprangers MAG (2008) EORTC QLQ-C30 reference values, 419 pp
Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37(11):1345–1351
Snyder CF, Dy SM, Hendricks DE, Brahmer JR, Carducci MA, Wolff AC, Wu AW (2007) Asking the right questions: investigating needs assessments and health-related quality-of-life questionnaires for use in oncology clinical practice. Support Care Cancer 15(9):1075–1085. doi:10.1007/s00520-007-0223-1
Carlson LE, Bultz BD (2003) Cancer distress screening. Needs, models, and methods. J Psychosom Res 55(5):403–409
Reese JB, Blackford A, Sussman J, Okuyama T, Akechi T, Bainbridge D, Howell D, Snyder CF (2015) Cancer patients’ function, symptoms and supportive care needs: a latent class analysis across cultures. Qual Life Res 24(1):135–146. doi:10.1007/s11136-014-0629-4
Snyder CF, Blackford AL, Okuyama T, Akechi T, Yamashita H, Toyama T, Carducci MA, Wu AW (2013) Using the EORTC-QLQ-C30 in clinical practice for patient management: identifying scores requiring a clinician’s attention. Qual Life Res 22(10):2685–2691. doi:10.1007/s11136-013-0387-8
Snyder CF, Blackford AL, Sussman J, Bainbridge D, Howell D, Seow HY, Carducci MA, Wu AW (2015) Identifying changes in scores on the EORTC-QLQ-C30 representing a change in patients’ supportive care needs. Qual Life Res 24(5):1207–1216. doi:10.1007/s11136-014-0853-y
Litofsky NS, Farace E, Anderson F Jr, Meyers CA, Huang W, Laws ER Jr, Glioma Outcomes Project I (2004) Depression in patients with high-grade glioma: results of the Glioma Outcomes Project. Neurosurgery 54 (2):358–366 (discussion 366–357)
Litofsky NS, Resnick AG (2009) The relationships between depression and brain tumors. J Neurooncol 94(2):153–161. doi:10.1007/s11060-009-9825-4
Mainio A, Hakko H, Niemela A, Koivukangas J, Rasanen P (2011) Depression in relation to anxiety, obsessionality and phobia among neurosurgical patients with a primary brain tumor: a 1-year follow-up study. Clin Neurol Neurosurg 113(8):649–653. doi:10.1016/j.clineuro.2011.05.006
Luckett T, King MT (2010) Choosing patient-reported outcome measures for cancer clinical research–practical principles and an algorithm to assist non-specialist researchers. Eur J Cancer 46(18):3149–3157. doi:10.1016/j.ejca.2010.08.002
Mor V, Laliberte L, Morris JN, Wiemann M (1984) The Karnofsky performance status scale. An examination of its reliability and validity in a research setting. Cancer 53(9):2002–2007
Myers J, Gardiner K, Harris K, Lilien T, Bennett M, Chow E, Selby D, Zhang L (2010) Evaluating correlation and interrater reliability for four performance scales in the palliative care setting. J Pain Symptom Manage 39(2):250–258. doi:10.1016/j.jpainsymman.2009.06.013
Erharter A, Giesinger J, Kemmler G, Schauer-Maurer G, Stockhammer G, Muigg A, Hutterer M, Rumpold G, Sperner-Unterweger B, Holzner B (2010) Implementation of computer-based quality-of-life monitoring in brain tumor outpatients in routine clinical practice. J Pain Symptom Manage 39(2):219–229. doi:10.1016/j.jpainsymman.2009.06.015
Halkett GK, Lobb EA, Oldham L, Nowak AK (2010) The information and support needs of patients diagnosed with high grade glioma. Patient Educ Couns 79(1):112–119. doi:10.1016/j.pec.2009.08.013
Meyers CA, Hess KR, Yung WK, Levin VA (2000) Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol 18(3):646–650
Sherer M, Meyers CA, Bergloff P (1997) Efficacy of postacute brain injury rehabilitation for patients with primary malignant brain tumors. Cancer 80(2):250–257
Taphoorn MJ, Klein M (2004) Cognitive deficits in adult patients with brain tumours. Lancet Neurol 3(3):159–168. doi:10.1016/S1474-4422(04)00680-5
Gehring K, Sitskoorn MM, Aaronson NK, Taphoorn MJ (2008) Interventions for cognitive deficits in adults with brain tumours. Lancet Neurol 7(6):548–560. doi:10.1016/S1474-4422(08)70111-X
Stulemeijer M, Vos PE, Bleijenberg G, van der Werf SP (2007) Cognitive complaints after mild traumatic brain injury: things are not always what they seem. J Psychosom Res 63(6):637–645. doi:10.1016/j.jpsychores.2007.06.023
Benedict RH, Cox D, Thompson LL, Foley F, Weinstock-Guttman B, Munschauer F (2004) Reliable screening for neuropsychological impairment in multiple sclerosis. Mult Scler 10(6):675–678
Hall KE, Isaac CL, Harris P (2009) Memory complaints in epilepsy: an accurate reflection of memory impairment or an indicator of poor adjustment? A review of the literature. Clin Psychol Rev 29(4):354–367. doi:10.1016/j.cpr.2009.03.001
Schagen SB, Boogerd W, Muller MJ, Huinink WT, Moonen L, Meinhardt W, Van Dam FS (2008) Cognitive complaints and cognitive impairment following BEP chemotherapy in patients with testicular cancer. Acta Oncol 47(1):63–70. doi:10.1080/02841860701518058
Gehring K, Taphoorn MJ, Sitskoorn MM, Aaronson NK (2015) Predictors of subjective versus objective cognitive functioning in patients with stable grades II and III glioma. Neurooncol Pract 2(1):20–31. doi:10.1093/nop/npu035
Bunevicius A, Tamasauskas S, Deltuva V, Tamasauskas A, Radziunas A, Bunevicius R (2014) Predictors of health-related quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective. Acta Neurochir (Wien) 156(2):367–374. doi:10.1007/s00701-013-1930-7
Ruden E, Reardon DA, Coan AD, Herndon JE 2nd, Hornsby WE, West M, Fels DR, Desjardins A, Vredenburgh JJ, Waner E, Friedman AH, Friedman HS, Peters KB, Jones LW (2011) Exercise behavior, functional capacity, and survival in adults with malignant recurrent glioma. J Clin Oncol 29(21):2918–2923. doi:10.1200/JCO.2011.34.9852
McLachlan SA, Allenby A, Matthews J, Wirth A, Kissane D, Bishop M, Beresford J, Zalcberg J (2001) Randomized trial of coordinated psychosocial interventions based on patient self-assessments versus standard care to improve the psychosocial functioning of patients with cancer. J Clin Oncol 19(21):4117–4125
Bampoe J, Laperriere N, Pintilie M, Glen J, Micallef J, Bernstein M (2000) Quality of life in patients with glioblastoma multiforme participating in a randomized study of brachytherapy as a boost treatment. J Neurosurg 93(6):917–926. doi:10.3171/jns.2000.93.6.0917
Fountain DM, Allen D, Joannides AJ, Nandi D, Santarius T, Chari A (2016) Reporting of patient-reported health-related quality of life in adults with diffuse low-grade glioma: a systematic review. Neuro-oncol. doi:10.1093/neuonc/now107
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This article contains parts of the dissertation of Mareile Janko, Karoline Kohlmann and Ann Katrin Reuter. Native language editing has been performed by Kathy Taylor.
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Jan Coburger and Mirjam Renovanz shared authorship, both authors have contributed equally to the planning of the underlying study and the completion of this manuscript.
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Hickmann, AK., Hechtner, M., Nadji-Ohl, M. et al. Evaluating patients for psychosocial distress and supportive care needs based on health-related quality of life in primary brain tumors: a prospective multicenter analysis of patients with gliomas in an outpatient setting. J Neurooncol 131, 135–151 (2017). https://doi.org/10.1007/s11060-016-2280-0
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DOI: https://doi.org/10.1007/s11060-016-2280-0