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Journal of Neuro-Oncology

, Volume 30, Issue 1, pp 71–80 | Cite as

Quality of life in brain tumor patients

  • Anna Rita Giovagnoli
  • Marcello Tamburini
  • Amerigo Boiardi
Clinical Study

Summary

With the aim of evaluating the quality of life (QL) of 101 brain tumor patients, a multidimensional approach was adopted, using the Functional Living Index - Cancer (FLIC) as a global measure of well-being, the Karnofsky Performance Scale (KPS) and the Index of Independence in Activity of Daily Living (ADL) as indices of physical and functional dimensions, the State-Trait Anxiety Inventory (STAI) and the Self-Rating Depression Scale (SRDS) for psychological assessment, and neuropsychological tests for abstract reasoning, attention, memory and frontal lobe functions. The patients were grouped on the grounds of disease stage and treatment The FLIC and KPS ratings increased from the patients who had just undergone surgery to patients who were disease-free after completing chemotherapy and radiotherapy, thus showing that the QL may improve during the disease despite aggressive treatments, providing there is no tumor recurrence. However, only the FLIC consistently discriminated the patients' stratification. The ADL revealed no between-group differences, whereas the STAI and SRDS revealed the presence of emotional troubles at the beginning and at the end of treatment. Cognitive impairment was more serious after radiotherapy and chemotherapy, as well as in patients with tumor recurrence. The FLIC significantly correlated with all of the other scales used, showing that it is useful in summarizing both the physical and psychosocial impairment of brain tumor patients. Of the pathological variables, a tumor location in the anterior right hemisphere or diencephalon was associated with high FLIC ratings, may be due to the minor cognitive impairment observed in patients with these tumor sites. Of the demographic variables, the level of education was associated with high FLIC ratings, thus highlighting the role of psychosocial environment in improving the QL. The use of a multidimensional approach or a global index of well-being that also reflects psychosocial and cognitive aspects proved to be more appropriate than traditional functional instruments (such as the KPS) in assessing the QL of brain tumor patients and in detecting the extent of the disease.

Key words

quality of life brain tumors functional living index-cancer 

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References

  1. 1.
    Donovan K, Samson-Fisher RW, Redman S: Measuring quality of life of cancer patients. J Clin Oncol 7:959–968, 1989Google Scholar
  2. 2.
    Hochberg FH, Linggood R, Wolfson L, Baker WH, Kornblith P: Quality and duration of survival in glioblastoma multiforme. Combined surgical, radiation, and lomustine therapy. JAMA 241:1016–1018,1979Google Scholar
  3. 3.
    Ammirati M, Vick N, Liao Y, Ciric I, Mikhael M: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastoma and anaplastic astrocytomas. Neurosurgery 21: 201–206,1987Google Scholar
  4. 4.
    Mostow EN, Byrne J, Connelly RR, Mulvihill JJ: Quality of life in long-term survivors of CNS tumors of childhood and adolescence. J Clin Oncol 9: 592–599,1991Google Scholar
  5. 5.
    Hochberg FH, Slotnick B: Neuropsychological impairment in astrocytoma survivors. Neurology 30:172–177,1980Google Scholar
  6. 6.
    Lieberman AN, Foo SH, Ranshoff J, Wise A, George A, Gordon W, Walker R: Long term survival among patients with malignant brain tumors. Neurosurgery 10: 450–453, 1982Google Scholar
  7. 7.
    Imperato JP, Paleologos NA, Vich NA: Effects of treatment on long-term survivors with malignant astrocytomas. Ann Neurol 28: 818–822,1990Google Scholar
  8. 8.
    Giovagnoli AR, Boiardi A: Cognitive impairment and quality of life in long-term survivors of malignant brain tumors. Ital J Neurol Sci 15: 481–488,1994Google Scholar
  9. 9.
    Mackworth N, Fobair P, Prados MD: Quality of life self-reports from 200 brain tumor patients: comparisons with Karnofsky performance scores. J Clin Oncol 14: 243–253, 1992Google Scholar
  10. 10.
    Taphoorn MJB, Heimans JJ, Snoeck FJ, Lindeboom J, Oosterink B, Wolbers JG, Karim ABM: Assessment of quality of life in patients treated for low-grade glioma: a preliminary report. J Neurol Neurosurg Psychiat 55: 372–376,1992Google Scholar
  11. 11.
    Schipper H., Clinch J, McMurray A, Levitt M: Measuring the quality of life of cancer patients: the Functional Living Index-Cancer: development and validation. J Clin Oncol 2: 472–483,1984Google Scholar
  12. 12.
    Ganz PA, Haskell CM, Figlin R, La Sota N, Siau J: Estimating the quality of life in a clinical trial of patients with metastatic lung cancer using the Karnofsky performance status and the Functional Living Index-Cancer. Cancer 61: 849–856, 1988Google Scholar
  13. 13.
    Karnofsky DA, Burchenai JH: The clinical evaluation of chemotherapeutic agents in cancer. In: McLeod CM (ed) Evaluation of Chemotherapeutic Agents. Columbia University Press, New York, 1949, pp 191–205Google Scholar
  14. 14.
    Tannock I, Murphey K: Reflection on medical oncology: an appeal for better clinical trials and improved reporting of their results. J Clin Oncol 1: pp 66–70,1983Google Scholar
  15. 15.
    Yates JW, Chalmer B, McKegney FP: Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 40: 2220–2224,1980Google Scholar
  16. 16.
    Schag CC, Heinrich RL, Ganz PA: Karnofsky performance scale revisited: reliability, validity and guidlines. J Clin Oncol 2:187–193,1984Google Scholar
  17. 17.
    Katz S, Downs TD, Cash HR: Progress in development of an index of ADL. Gerontologist 10: 20–30,1970Google Scholar
  18. 18.
    Zung WWK: A self-rating depression scale. Arch Gen Psychiat 12:63–70,1965Google Scholar
  19. 19.
    Spielberger CD, Gorsuch RL, Lushene RE: Manual for the State-Trait Anxiety Inventory. Consulting Psychologist Press, Palo Alto, California, 1970Google Scholar
  20. 20.
    Spielberger CD: Inventario per l'ansia di ‘stato’ e di ‘tratto’. Manuale. Organizzazioni Speciali, Firenze, Italia,1989Google Scholar
  21. 21.
    Zung WWK: A cross-cultural survey of symptoms in depression. Amer J Psychiat:154-159,1969Google Scholar
  22. 22.
    Basso A, Capitani E, Laiacona M: Raven's coloured progressive matrices: normative values on 305 adult normal controls. Func Neurol 2:189–194,1987Google Scholar
  23. 23.
    Nelson HE: A modified card sorting test sensitive to frontal lobe defects. Cortex 12: 313–324,1976PubMedGoogle Scholar
  24. 24.
    Spinnler H, Tognoni G: Standardizzazione e taratura italiana di test neuropsicologici. It J Neurol Sci, suppl 8,1987Google Scholar
  25. 25.
    Lezak M: Neuropsychological Assessment. Oxford University Press, New York, 1983Google Scholar
  26. 26.
    Novelli G, Papagno C, Capitani E, Laiacona M, Cappa SF, Vallar G: Tre test clinici di memoria verbale a lungo termine. Taratura su soggetti normali. Arch Psicol Neurol Psichiat 47: 278–296,1986Google Scholar
  27. 27.
    Ganz PA, Lee JJ, Sian J: Quality of life assessment. An inde-pendent prognostic variable for survival in lung cancer. Cancer 67: 3131–3135,1991Google Scholar
  28. 28.
    Silverman CL, Palkes H, Talent B, Kovnar E, Clouse JW Thomas PRM: Late effects of radiotherapy on patients with cerebellar medulloblastoma. Cancer 54: 825–829,1984Google Scholar
  29. 29.
    Lee YY, Nanert C, Glass JP: Treatment-related white matter changes in cancer patients. Cancer 57: 1473–1482,1986Google Scholar
  30. 30.
    De Angelis LM, Delattre JK, Posner JB: Radiation-induced dementia in patients cured of brain metastases. Neurology 39:789–796,1989Google Scholar
  31. 31.
    Duffner PK: Long-term effects of treatment. In: Bradly WG, Daroff RB, Fenichel GM, Marsden CD (eds) Neurology in Clinical Practice. Butterworth-Heinemann, 1989, pp 1046–1047Google Scholar
  32. 32.
    Cavazzuti V, Fisher EG, Welch K, Belli JA, Winston KR: Neurological and psychological sequaele following different treatments of craniopharyngioma in children. J Neurosurg 59: 409–417,1983Google Scholar
  33. 33.
    Crossen JR, Goldman DL, Dahlborg SAN, Neuwelt EA: Neuropsychological assessment outcomes of nonacquired immunodeficiency syndrome patients with primary central nervous system lymphoma before and after blood-brain barrier disruption chemotherapy. Neurosurgery 30: 23–29, 1992Google Scholar
  34. 34.
    Marie J, Coudin B, Guerin J, Caudry M: Neuropsychological impairment in adults with brain tumors. Amer J Clin Oncol 10:156–162,1987Google Scholar
  35. 35.
    Sichez N, Fauchon F, Chantelard JV, Hecht F, Vega F, Poisson M, Delattre JY: Quality of life in long term survivors of astrocytomas treated with surgery and radiation therapy: a neuropsychological study. Abstracts II Meeting European Neurological Society, 1990, p S2Google Scholar
  36. 36.
    Salcman M, Kaplan RS, Ducker TB, Abdo H, Montgomery E: Effect of age and reoperation on survival in the combined modality treatment of malignant astrocytoma. Neurosurgery 10: 454–463,1982Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Anna Rita Giovagnoli
    • 2
  • Marcello Tamburini
    • 1
  • Amerigo Boiardi
    • 2
  1. 1.Department of NeurologyNational Neurologic InstituteMilanoItaly
  2. 2.Department of Psychologic ResearchNational Cancer InstituteMilanoItaly

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