Supportive Care in Cancer

, Volume 20, Issue 1, pp 57–64 | Cite as

Factors influencing quality of life in patients with benign primary brain tumors: prior to and following surgery

  • Shiow-Luan Tsay
  • Jui-Yen Chang
  • Patsy Yates
  • Kuan-Chia Lin
  • Shu-Yuan LiangEmail author
Original Article



Few studies have repeatedly evaluated quality of life and potentially relevant factors in patients with benign primary brain tumor. The purpose of this study was to explore the relationship between the experience of the symptom distress, functional status, depression, and quality of life prior to surgery (T1) and 1 month post-discharge (T2).

Patients and methods

This was a prospective cohort study including 58 patients with benign primary brain tumor in one teaching hospital in the Taipei area of Taiwan. The research instruments included the M.D. Anderson Symptom Inventory, the Functional Independence Measure scale, the Hospital Depression Scale, and the Functional Assessment of Cancer Therapy-Brain.


Symptom distress (T1: r = −0.90, p < 0.01; T2: r = −0.52, p < 0.01), functional status (T1: r = 0.56, p < 0.01), and depression (T1: r = −0.71, p < 0.01) demonstrated a significant relationship with patients' quality of life. Multivariate analysis identified symptom distress (explained 80.2%, R inc 2  = 0.802, p = 0.001) and depression (explained 5.2%, R inc 2  = 0.052, p < 0.001) continued to have a significant independent influence on quality of life prior to surgery (T1) after controlling for key demographic and medical variables. Furthermore, only symptom distress (explained 27.1%, R inc 2  = 0.271, p = 0.001) continued to have a significant independent influence on quality of life at 1 month after discharge (T2).


The study highlights the potential importance of a patient's symptom distress on quality of life prior to and following surgery. Health professionals should inquire about symptom distress over time. Specific interventions for symptoms may improve the symptom impact on quality of life. Additional studies should evaluate symptom distress on longer-term quality of life of patients with benign brain tumor.


Symptom distress Quality of life Brain tumor 



The authors would like to thank Dr. Chieh-Yu Liu for comments on statistics. This study was supported by Grant NSC96-2628-B-227-001-MY2 from the National Science Council of Taiwan.


  1. 1.
    Department of Health, Bureau of Health Promotion, Taiwan, ROC (2010) Research & statistic. Available at Access 5 June 2010
  2. 2.
    Armstrong TS, Cohen MZ, Eriksen LR, Hickey JV (2004) Symptom clusters in oncology patients and implication for symptom research in people with primary brain tumor. J Nurs Sch 36:197–206CrossRefGoogle Scholar
  3. 3.
    Pelletier G, Verhoef MJ, Khatri N, Hagen N (2002) Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. J Neuro Oncol 57:41–49CrossRefGoogle Scholar
  4. 4.
    Bosma I, Reijneveld JC, Douw L, Vos MJ, Postma TJ, Aaronson NK, Muller M, Vandertop WP, Slotman MJ, Taphoorn JB, Heimans JJ, Klein M (2009) Health-related quality of life of long-term high-grade glioma survivors. Neuro Oncol 11:51–58PubMedCrossRefGoogle Scholar
  5. 5.
    Sehlen S, Lenk M, Hollenhorst H et al (2003) Quality of life as a predictive mediator variable for survival in patients with intracerebral neoplasma during radiotherapy. Onkologie 26:38–43PubMedCrossRefGoogle Scholar
  6. 6.
    Mukand JA, Blackinton DD, Crincoli M, Lee JJ, Santos BB (2001) Incidence of neurologic deficits and rehabilitation of patients with brain tumors. Am J Phys Med Rehabil 80:346–350PubMedCrossRefGoogle Scholar
  7. 7.
    Ullrich NJ, Scott RM, Pomeroy SL (2005) Craniopharyngioma therapy: long term effects on hypothalamic function. Neurologist 11:55–60PubMedCrossRefGoogle Scholar
  8. 8.
    Giovagnli AR (1999) Quality of life in patients with stable disease after surgery, radio-therapy, and chemotherapy for malignant brain tumor. J Neurol Neurosurg Psychiatry 67:358–363CrossRefGoogle Scholar
  9. 9.
    Liu L, Fiorentino L, Natarajan L, Parker BA, Mills P, Sadler GR, Dimsdale JE, Rissling M, He F, Ancoli-Israel S (2009) Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Psycho Oncol 18:187–194CrossRefGoogle Scholar
  10. 10.
    Mackworth N, Fobair P, Prados MD (1992) Quality of life self-reports from 200 brain tumor patients: comparisons with Karnofsky scores. J Neuro Oncol 14:243–253CrossRefGoogle Scholar
  11. 11.
    Cleeland CS, Mendoza TR, Wang XS et al (2000) Assessing symptom distress in cancer patients: the M. D. Anderson Symptom Inventory. Cancer 89:1634–1646PubMedCrossRefGoogle Scholar
  12. 12.
    Lin CC, Chang AP, Cleeland CS, Mendoza TR, Wang XS (2007) Anderson symptom inventory: symptom assessment in cancer patients. J Pain Symptom Manag 33:180–188CrossRefGoogle Scholar
  13. 13.
    Hamilton BB, Granger CV, Sherwin FS et al (1987) A uniform national data system for medical rehabilitation. In: Fuhrer MJ (ed) Rehabilitation outcomes: analysis and measurement. Brookes, Baltimore, pp 137–147Google Scholar
  14. 14.
    Ottenbacher KKJ, Hsu Y, Granger C, Fiedler R (1996) The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehab 77:1226–1232CrossRefGoogle Scholar
  15. 15.
    Liaw LJ (2000) Reliability and validity of the interview based functional independence measure in patients with stroke. Kaohsiung Medical University, KaohsiungGoogle Scholar
  16. 16.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 52:69–77PubMedCrossRefGoogle Scholar
  17. 17.
    Zigmond A, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar
  18. 18.
    Weitzner MA, Meyers CA, Gelke CK, Byrne KS, Cella DF, Levin VA (1995) The functional assessment of cancer therapy (FACT) scale: development of a brain subscale and revalidation of the general version (FACT-G) in patients with primary brain tumor. Cancer 75:1151–1161PubMedCrossRefGoogle Scholar
  19. 19.
    One ZH (2006) The evaluation of Chinese version of functional assessment of cancer therapy (FACT). J Pract Oncol 21:77–80Google Scholar
  20. 20.
    Kenefick AL (2006) Patterns of symptom distress in older women after surgical treatment for breast cancer. Oncol Nurs Forum 33:327–335PubMedCrossRefGoogle Scholar
  21. 21.
    Lovrics PJ, Cornacchi SD, Barnabi F, Whelan T, Goldsmith CH (2008) The feasibility and responsiveness of the health utilities index in patients with early-stage breast cancer: a prospective longitudinal study. Qual Life Res 17:333–345PubMedCrossRefGoogle Scholar
  22. 22.
    Quintard B, Lakdja F (2008) Assessing the effect of beauty treatments on psychological distress, body image, and coping: a longitudinal study of patients undergoing surgical procedures for breast cancer. Psycho Oncol 17:1032–1038CrossRefGoogle Scholar
  23. 23.
    Mundy EA, Blanchard EB, Cirenza E et al (2000) Posttraumatic stress disorder in breast cancer patients following autologous bone marrow transplantation or conventional cancer treatment. Behav Res Ther 38:1015–1027PubMedCrossRefGoogle Scholar
  24. 24.
    Armstrong TS, Gning I, Mendoza TR, Weinberg JS, Gilbert MR, Tortorice ML, Cleeland CS (2009) Clinical utility of the MDASI-BT in patients with brain metastases. J Pain Symptom Manag 37:331–340CrossRefGoogle Scholar
  25. 25.
    Chang VT, Hwang SS, Feuerman M, Kasimis BS (2000) Symptom and quality of life survey of medical oncology patients at a veteran affairs medical center: a role for symptom assessment. Cancer 88:1175–1183PubMedCrossRefGoogle Scholar
  26. 26.
    Portenoy RK, Thaler HT, Kornblith AB et al (1994) Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res 3:183–189PubMedCrossRefGoogle Scholar
  27. 27.
    Anderson SI, Taylor R, Whittle IR (1999) Mood disorders in patients after treatment for primary intracranial tumors. Br J Neurosurg 13:480–485PubMedGoogle Scholar
  28. 28.
    Chung JWY, Wong TKS, Yang JCS (2000) The lens model: assessment of cancer pain in a Chinese context. Cancer Nurs 23:454–461PubMedCrossRefGoogle Scholar
  29. 29.
    Huang ME, Wartella JE, Kreutzer JS (2001) Functional outcomes and quality of life in patients with brain tumor: a preliminary report. Arch Phys Med Rehab 82:1540–1546CrossRefGoogle Scholar
  30. 30.
    Pit-ten Cate IM, Kennedy C, Stevenson J (2002) Disability and quality of life in spina bifida and hydrocephalus. Dev Med Child Neurol 44:317–322CrossRefGoogle Scholar
  31. 31.
    Fisch MJ, Loehrer PJ, Kristeller J et al (2003) Fluoxetine versus placebo in advanced cancer outpatients: a double-blind trial of the Hoosier Oncology Group. J Clin Oncol 21:1937–1943PubMedCrossRefGoogle Scholar
  32. 32.
    Molassiotis A, Sylt P, Diggins H (2006) The management of cancer- related fatigue after chemotherapy with acupuncture and acupressure: a randomized controlled trial. Complement Ther Med 15:228–237PubMedCrossRefGoogle Scholar
  33. 33.
    Salander P, Bergenheim AT, Henriksson R (2000) How was life after treatment of a malignant brain tumor? Soc Sci Med 51:589–598PubMedCrossRefGoogle Scholar
  34. 34.
    Savard J, Simard S, Giquere I et al (2006) Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: psychological and immunological effects. Palliat Support Care 4:219–237PubMedCrossRefGoogle Scholar
  35. 35.
    Strang S, Strang P (2001) Spiritual thoughts, coping and “sense of coherence” in brain tumor patients and their spouses. Palliat Med 15:127–134PubMedCrossRefGoogle Scholar
  36. 36.
    Williams S, Dale J (2006) The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 94:372–390PubMedCrossRefGoogle Scholar
  37. 37.
    Nei-Dwyer G, Lang DA, Davis A (2000) Outcome from complex neurosurgery: an evidence based approach. Acta Neurochir 142:367–371CrossRefGoogle Scholar
  38. 38.
    Kelleher MO, Fernandes MF, Sim DW, O'sullivan MG (2002) Health-related quality of life in patients with skull base tumors. Br J Neurosurg 16:16–20PubMedCrossRefGoogle Scholar
  39. 39.
    Mainio A, Tuunanen S, Hakko H et al (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 256:516–521PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Shiow-Luan Tsay
    • 1
  • Jui-Yen Chang
    • 2
  • Patsy Yates
    • 3
  • Kuan-Chia Lin
    • 1
  • Shu-Yuan Liang
    • 1
    Email author
  1. 1.School of NursingNational Taipei University of Nursing and Health ScienceTaipeiTaiwan
  2. 2.Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.School of Nursing, Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia

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