Abstract
Patients with primary brain tumors (PBT) face uncertainty related to prognosis, symptoms and treatment response and toxicity. Uncertainty is correlated to negative mood states and symptom severity and interference. This study identified predictors of uncertainty during different treatment stages (newly-diagnosed, on treatment, followed-up without active treatment). One hundred eighty six patients with PBT were accrued at various points in the illness trajectory. Data collection tools included: a clinical checklist/a demographic data sheet/the Mishel Uncertainty in Illness Scale-Brain Tumor Form. The structured additive regression model was used to identify significant demographic and clinical predictors of illness-related uncertainty. Participants were primarily white (80 %) males (53 %). They ranged in age from 19-80 (mean = 44.2 ± 12.6). Thirty-two of the 186 patients were newly-diagnosed, 64 were on treatment at the time of clinical visit with MRI evaluation, 21 were without MRI, and 69 were not on active treatment. Three subscales (ambiguity/inconsistency; unpredictability-disease prognoses; unpredictability-symptoms and other triggers) were different amongst the treatment groups (P < .01). However, patients’ uncertainty during active treatment was as high as in newly-diagnosed period. Other than treatment stages, change of employment status due to the illness was the most significant predictor of illness-related uncertainty. The illness trajectory of PBT remains ambiguous, complex, and unpredictable, leading to a high incidence of uncertainty. There was variation in the subscales of uncertainty depending on treatment status. Although patients who are newly diagnosed reported the highest scores on most of the subscales, patients on treatment felt more uncertain about unpredictability of symptoms than other groups. Due to the complexity and impact of the disease, associated symptoms, and interference with functional status, comprehensive assessment of patients is necessary throughout the illness trajectory.
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Acknowledgments
The authors would like to thank the research subjects for their participation. The authors would also like to thank the CERN Foundation for the support of research assistant for data collection. This study is supported by the Dean’s Research Award from UT-Houston and the Collaborative Ependymoma Research Network (CERN Foundation).
Conflict of interests
Mark R. Gilbert—Advisory Boards: Genentech/Roche, Merck, Abbvie; Honoraria: Genentech/Roche, Merck. Terri Armstrong—Research Support: Genetech/Roche, Merck; Consultant: Immunocyte, Bristol Meyers. All remaining authors have no disclosures.
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Lin, L., Chien, LC., Acquaye, A.A. et al. Significant predictors of patients’ uncertainty in primary brain tumors. J Neurooncol 122, 507–515 (2015). https://doi.org/10.1007/s11060-015-1756-7
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DOI: https://doi.org/10.1007/s11060-015-1756-7