Prospective Study of Quality of Life in Adults with Newly Diagnosed High-grade Gliomas
- First Online:
To assess baseline quality of life (QOL) and its prognostic importance for adults with newly diagnosed high-grade gliomas, we analyzed QOL and outcome data prospectively collected in three phase II high-grade glioma protocols.
At study entry, patients completed five self-administered forms to assess overall QOL (linear analogue scale assessment [LASA] and Functional Assessment of Cancer Therapy-Brain [FACT-Br]); fatigue (Symptom Distress Scale [SDS]); excessive daytime somnolence (Epworth Sleepiness Scale [ESS]); and depression (POMS-SF). Folstein Mini-Mental State Examination (MMSE) and Eastern Cooperative Oncology Group (ECOG) performance scores (PS) were obtained by the health care provider.
Baseline QOL data were available for 194 of 220 patients (88%) enrolled in the three protocols. Differences in baseline QOL among the three studies were not statistically significant. One-third of patients had clinically significant fatigue at baseline. Increased fatigue (P = 0.003), excessive daytime somnolence (P = 0.01), and lower overall QOL scores (LASA, P = 0.001; FACT-Br, P = 0.0001) correlated with worse ECOG PS. No relation was found between QOL and corticosteroid or anticonvulsant therapy, extent of resection, tumor grade, or sex. Multivariate analyses found worse ECOG PS (PS 2, P = 0.007) associated with increased fatigue. Worse ECOG PS (PS 2, P = 0.002) was also associated with worse overall QOL (LASA). On multivariate analyses of survival, increased fatigue (P = 0.003) predicted poorer overall survival.
Performance status is related to QOL in patients with newly diagnosed high-grade brain tumors. Increased fatigue is an independent predictor of overall survival. Interventional studies directed at improving QOL, especially fatigue, may have important benefits for these patients.
Keywordsbrain glioma multivariate analysis prognosis survival
classification and regression tree
Eastern Cooperative Oncology Group
Epworth Sleepiness Scale
Functional Assessment of Cancer Therapy-Brain
Gross Total Resection
Karnofsky performance scale
linear analogue scale assessment
Folstein Mini-Mental State Examination
North Central Cancer Treatment Group
Profiles of Mood States Short Form
quality of life
Symptom Distress Scale
Unable to display preview. Download preview PDF.
- 4.Rao, RD, Fitch, TR, Schomberg, PJ, Dinapoli, RP, Nordstrom, K, Boeve, BF, et al. 2002A phase II trial of pre-irradiation chemotherapy with BCNU, cisplatin and oral etoposide combined with radiation therapy in the treatment of grade 3 astrocytoma (anaplastic astrocytoma)Neurooncology4374375Google Scholar
- 5.Moynihan, TJ, O’Fallon, JR, Krook, JE, Schomberg, P, Dinapoli, RP, Kazem, I, et al. 2002A phase II trial of pre-irradiation chemotherapy with BCNU, cisplatin and oral etoposide combined with radiation therapy in the treatment of glioblastoma (GBM) [abstract]Proc ASCO2177aGoogle Scholar
- 7.Cella, DF 1996Quality of life outcomes: measurement and validationOncology (Huntingt)10 233246Google Scholar
- 16.Cassileth BR, Soloway MS, Vogelzang NJ, Chou JM, Shellhammer PD, Seidmon EJ, et al. and the Zoladex Prostate Cancer Study Group: Quality of life and psychosocial status in stage D prostate cancer. Qual Life Res 1: 323–330, 1992Google Scholar
- 22.Regine, WF, Schmitt, FA, Scott, C, Dearth, CA, Patchell, R, Nichols, RC,Jr, et al. 2002Feasibility of neurocognitive outcome evaluations in patients with brain metastases in a multi-institutional cooperative group setting: results of Radiation Therapy Oncology Group (RTOG) trial BR-0018 abstract]Int J Radiat Oncol Biol Phys5449Google Scholar
- 30.Meyers CA, Wefel SJ: The use of the mini-mental state examination to assess cognitive functioning in cancer trials: no ifs, ands, buts, or sensitivity. J Clin Oncol 21: 3557–3558, 2003. Epub 2003 August 11Google Scholar
- 35.Kaplan, EL, Meier, P 1958Nonparametric estimation from incomplete observationsJ Am Stat Assoc53457481Google Scholar
- 38.Cox, DR 1972Regression models and life-tablesJ R Stat Soc B34187202Google Scholar
- 39.Efron, B 1979Bootstrap methods: another look at the jackknifeAnn Stat7126Google Scholar
- 41.Sloan, JA Cella, D Frost, M Guyatt, GH Sprangers, M Symonds, T and the Clinical Significance Consensus Meeting Group2002Assessing clinical significance in measuring oncology patient quality of life: introduction to the symposium, content overview, and definition of termsMayo Clin Proc77367370PubMedGoogle Scholar
- 44.Buckner, JC, Schomberg, PJ, McGinnis, WL, Cascino, TL, Scheithauer, BW, O’Fallon, JR, et al. 2001A phase III study of radiation therapy plus carmustine with or without recombinant interferon-α in the treatment of patients with newly diagnosed high-grade gliomaCancer92420433CrossRefPubMedGoogle Scholar
- 49.Jason, GW, Pajurkova, EM, Taenzer, PA, Bultz, BD 1997Acute effects on neuropsychological function and quality of life by high-dose multiple daily fractionated radiotherapy for malignant astrocytomas:assessing the tolerability of a new radiotherapy regimenPsychooncology6151157CrossRefPubMedGoogle Scholar
- 51.Klein M, Taphoorn MJ, Heimans JJ, van der Ploeg HM, Vandertop WP, Smit EF, et al.: Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients. J Clin Oncol 19: 4037–4047, 2001. Erratum in: J Clin Oncol 21: 2628, 2003 and Curr Neurol Neurosci Rep 2: 203–204, 2002Google Scholar
- 56.Terhaard, C, Mehta, MP, Rodrigus, P, Rao, A, Suh, J, Roa, W, et al. 2002Quality of life (QOL) in patients (pts) with brain metastases (BM) is strongly related to MRI tumor volume and neurocognitive function (NCF): baseline results from the phase III trial of motexafin gadolinium (MGd)Proc ASCO2173aGoogle Scholar
- 59.Osoba, D, Brada, M, Prados, MD, Yung, WK 2000Effect of disease burden on health-related quality of life in patients with malignant gliomasNeurooncol2221228Google Scholar
- 67.Simpson, JR, Horton, J, Scott, C, Curran, WJ, Rubin, P, Fischbach, J, et al. 1993Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trialsInt J Radiat Oncol Biol Phys26239244PubMedGoogle Scholar