Acta Neurochirurgica

, Volume 160, Issue 5, pp 1053–1061 | Cite as

Patients’ reported outcome measures and clinical scales in brain tumor surgery: results from a prospective cohort study

  • Silvia Schiavolin
  • Alberto Raggi
  • Chiara Scaratti
  • Matilde Leonardi
  • Alberto Cusin
  • Sergio Visintini
  • Francesco Acerbi
  • Marco Schiariti
  • Costanza Zattra
  • Morgan Broggi
  • Paolo Ferroli
Original Article - Brain Tumors
Part of the following topical collections:
  1. Brain tumors



This study aims to assess surgical outcome in brain tumor surgery using patient reported outcome measures (PROMs) and to compare their results with traditional clinical outcome measurements.


Neuro-oncological patients undergoing surgical removal for the lesion were enrolled; MOCA test, PROMs (EUROHIS-QoL, PGWB-S, WHODAS-12), and the clinical scale Karnofsky Performance Status (KPS) were administered to evaluate respectively cognitive status, quality of life, well-being, disability, and functional status before surgery and at 3-month follow-up. Wilcoxon test was performed to evaluate the longitudinal change of test scores, the smallest detectable difference to classify the change of patients in PROMs, the Cohen kappa to investigate the concordance between KPS and PROMs in classifying the patients’ change, and Mann-Whitney U test to compare patients with complications and no complications.


A total of 101 patients were enrolled (54 woman, mean age 50.2 ± 14.1, range 20–85): psychological well-being improved at follow-up; 95 patients (94.1%) were improved/unchanged and 6 (5.9%) were worsened according to PROMs; functional status measured with KPS had a slight agreement with quality of life and disability and no agreement with psychological well-being questionnaires; patients with complications had a greater worsening in KPS.


According to PROMs measuring QoL, disability, and psychological well-being, most of the patients were improved/unchanged after surgery. Since PROMs and KPS detect different aspects of the patients’ health status, PROMs should be integrated in surgical outcome evaluation. Furthermore, their association with complications and with other clinical and subjective variables that could influence patient’s perception of health status should be investigated.


Brain tumor Neurosurgery Clinical outcome Patient reported outcomes 



This study was an independent examination on the presence of complications and quality of life in patients candidate to neurosurgical procedures (CQ-NCH), sponsored by the Neurological Institute C. Besta IRCCS Foundation.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    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 156:367–374CrossRefPubMedGoogle Scholar
  2. 2.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum, New JerseyGoogle Scholar
  3. 3.
    De Girolamo G, Rucci P, Scocco P, Becchi A, Coppa F, D'Addario A, Darú E, De Leo D, Galassi L, Mangelli L, Marson C, Neri G, Soldani L (2000) Quality of life assessment: validation of the Italian version of the WHOQOL-Brief. Epidemiol Psichiatr Soc 9:45–55CrossRefPubMedGoogle Scholar
  4. 4.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Drewes C, Sagberg LM, Jakola AS, Gulati S, Solheim O (2015) Morbidity after intracranial tumor surgery: sensitivity and specificity of retrospective review of medical records compared with patient-reported outcomes at 30 days. J Neurosurg 123:972–977CrossRefPubMedGoogle Scholar
  6. 6.
    Federici S, Meloni F, Mancini A, Lauriola M, Olivetti Belardinelli M (2009) World Health Organisation Disability Assessment Schedule II: contribution to the Italian validation. Disabil Rehabil 31:553–564CrossRefPubMedGoogle Scholar
  7. 7.
    Ferroli P, Broggi M, Schiavolin S, Acerbi F, Bettamio V, Caldiroli D, Cusin A, La Corte E, Leonardi M, Raggi A, Schiariti M, Visintini S, Franzini A, Broggi G (2015) Predicting functional impairment in brain tumor surgery: the Big Five and the Milan Complexity Scale. Neurosurg Focus 39:E14CrossRefPubMedGoogle Scholar
  8. 8.
    Grossi E, Groth N, Mosconi P, Cerutti R, Pace F, Compare A, Apolone G (2006) Development and validation of the short version of the Psychological General Well-Being Index (PGWB-S). Health Qual Life Outcomes 4:88CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hardesty DA, Sanai N (2012) The value of glioma extent of resection in the modern neurosurgical era. Front Neurol 3:140CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Jakola AS, Unsgård G, Solheim O (2011) Quality of life in patients with intracranial gliomas: the impact of modern image-guided surgery. J Neurosurg 114:1622–1630CrossRefPubMedGoogle Scholar
  11. 11.
    Janda M, Eakin EG, Bailey L, Walker D, Troy K (2006) Supportive care needs of people with brain tumours and their carers. Support Care Cancer 14:1094–1103CrossRefPubMedGoogle Scholar
  12. 12.
    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM (ed) Evaluation of chemotherapeutic agents Columbia. University Press, New York, pp 191–205Google Scholar
  13. 13.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  14. 14.
    Miao Y, Lu X, Qiu Y, Jiang J, Lin Y (2010) A multivariate analysis of prognostic factors for health-related quality of life in patients with surgically managed meningioma. J Clin Neurosci 17:446–449CrossRefPubMedGoogle Scholar
  15. 15.
    Pirani A, Tulipani C, Neri M (2006) Italian translation of MoCA test and of its instructions Accessed 9 Oct 2017
  16. 16.
    Renovanz M, Gutenberg A, Haug M, Strittmatter E, Mazur J, Nadji-Ohl M, Giese A, Hopf N (2013) Postsurgical screening for psychosocial disorders in neurooncological patients. Acta Neurochir 155:2255–2261CrossRefPubMedGoogle Scholar
  17. 17.
    Reponen E, Tuominen H, Hernesniemi J, Korja M (2015) Patient-reported outcomes in elective cranial neurosurgery. World Neurosurg 84:1845–1851CrossRefPubMedGoogle Scholar
  18. 18.
    Sagberg LM, Drewes C, Jakola AS, Solheim O (2017) Accuracy of operating neurosurgeons’ prediction of functional levels after intracranial tumor surgery. J Neurosurg 126:1173–1180CrossRefPubMedGoogle Scholar
  19. 19.
    Santangelo G, Siciliano M, Pedone R, Vitale C, Falco F, Bisogno R, Siano P, Barone P, Grossi D, Santangelo F, Trojano L (2015) Normative data for the Montreal Cognitive Assessment in an Italian population sample. Neurol Sci 36:585–591CrossRefPubMedGoogle Scholar
  20. 20.
    Schiavolin S, Ferroli P, Acerbi F, Brock S, Broggi M, Cusin A, Schiariti M, Visintini S, Quintas R, Leonardi M, Raggi A (2014) Disability in Italian neurosurgical patients: validity of the 12-item World Health Organization Disability Assessment Schedule. Int J Rehabil Res 37:267–270CrossRefPubMedGoogle Scholar
  21. 21.
    Schiavolin S, Quintas R, Ferroli P, Acerbi F, Brock S, Cusin A, Schiariti M, Visintini S, Broggi M, Leonardi M, Raggi A (2015) Quality of life measures in Italian neurosurgical patients: validity of the EUROHIS-QOL 8-item index. Qual Life Res 24:441–444CrossRefPubMedGoogle Scholar
  22. 22.
    Schmidt S, Mühlan H, Power M (2006) The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study. Eur J Pub Health 16:420–428CrossRefGoogle Scholar
  23. 23.
    Ustun TB, Kostanjsek N, Chatterji S, Rehm J (2010) Measuring health and disability: manual for the WHO Disability Assessment Schedule (WHODAS 2.0). WHO, GenevaGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Silvia Schiavolin
    • 1
  • Alberto Raggi
    • 1
  • Chiara Scaratti
    • 1
  • Matilde Leonardi
    • 1
  • Alberto Cusin
    • 2
  • Sergio Visintini
    • 2
  • Francesco Acerbi
    • 2
  • Marco Schiariti
    • 2
  • Costanza Zattra
    • 2
  • Morgan Broggi
    • 2
  • Paolo Ferroli
    • 2
  1. 1.Neurology, Public Health and Disability UnitNeurological Institute C. Besta IRCCS FoundationMilanItaly
  2. 2.Division of Neurosurgery IINeurological Institute C. Besta IRCCS FoundationMilanItaly

Personalised recommendations