Adherence to Long‐Term Follow‐up in Patients With Sporadic Vestibular Schwannomas Managed With Serial Observation

Raymond, Mallory; Ghanouni, Arian; Brooks, Kaitlyn A.; Clark, Sarah M.; Mattox, Douglas E.

doi:10.1177/2473974x211036653

Cited by 3 publications

(5 citation statements)

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“…Recently, Raymond et al published a retrospective chart review based in Atlanta, Georgia, that highlighted no significant association between common demographical factors (eg, age, insurance status, racial background) and adherence to serial follow‐up in 121 VS patients 10 . Similarly, Hillman et al demonstrated a lack of significance between patient preoperative and tumor variables with risk of failure to follow‐up in their patient cohort situated in Pittsburgh, Pennsylvania 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Patient adherence to initial follow‐up can be improved in many fronts. Prior studies interviewing VS patients who failed to follow‐up highlighted that misconceptions about their VS diagnosis and intentional noncompliance were common reasons 9,10 . Increased efforts in patient education upfront at the initial time of diagnosis could help tackle such issues.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies interviewing VS patients who failed to follow-up highlighted that misconceptions about their VS diagnosis and intentional noncompliance were common reasons. 9,10 Increased efforts in patient education upfront at the initial time of diagnosis could help tackle such issues. In addition, with the uptrend in virtual appointments since the COVID-19 pandemic, patient adherence could be improved through introducing telehealth appointments as a follow-up option to give patients more flexibility.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, 42.6% of 122 patients failed to follow‐up, however, no clear variable could be identified as a risk factor for loss to follow‐up 9 . Another study cited that 44.2% of patients did not return for a second visit and that ultimately all but 3 out of 95 patients were lost to follow‐up; similarly no risk factors, including sex, race, age at diagnosis, initial tumor size, insurance status, household income, or driving distance to hospital, were identified 10 . However, both studies were limited by a relatively small sample size.…”

mentioning

confidence: 99%

“…9 Another study cited that 44.2% of patients did not return for a second visit and that ultimately all but 3 out of 95 patients were lost to follow-up; similarly no risk factors, including sex, race, age at diagnosis, initial tumor size, insurance status, household income, or driving distance to hospital, were identified. 10 However, both studies were limited by a relatively small sample size. More research is thus needed to evaluate factors impacting follow-up compliance.…”

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confidence: 99%

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Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

Wang,

Asfour,

Yang

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo examine patient characteristics that impact serial observation adherence among vestibular schwannoma (VS) patients.Study DesignRetrospective chart review.SettingSingle tertiary care center.MethodsWe selected for VS patients from 201 to 2020 who elected for serial observation as initial management. Patients under 18, with previous management, bilateral or intralabyrinthine VS, and neurofibromatosis type 2 were excluded. Demographics, tumor characteristics, and follow‐up status were extracted. Single and multiple logistic regression was used to identify patient characteristics impacting follow‐up.ResultsWe identified 507 VS patients who chose serial observation as initial management. Most were female (56.0%), white (73.0%), and married (72.8%). The mean age was 59.3 and most had private insurance (56.4%). Median Charlson Comorbidity Index was 2.00. Mean pure tone audiometry (PTA) average was 41.7 Hz. Average tumor size was 9.04 mm. Of 507 patients, 358 (70.6%) returned for at least one follow‐up. On multiple logistic regression analysis, patients with private insurance (odds ratio [OR]: 0.39, confidence interval [CI]: 0.22‐0.68; P = .001), racial minority background (OR: 0.54, CI: 0.35‐0.83; P = .005), worse PTA averages (OR: 0.99, CI: 0.98‐1.00; P = .044), and older age at diagnosis (OR: 0.97, CI: 0.95‐1.00; P = .038) were less likely to follow‐up.ConclusionPrivate health insurance, racial minority background, worse PTA average, and older age were associated with decreased follow‐up among adult VS patients electing serial observation. Patients with these characteristics may require additional support to ensure serial observation adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

Wang,

Asfour,

Yang

et al. 2024

Otolaryngol.--head neck surg.

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Documented Initial Growth Does Not Necessarily Indicate Treatment for Sporadic Vestibular Schwannomas

Bourque,

Panizza

2024

Otol Neurotol

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Objective To report the natural history of vestibular schwannoma (VS) who elected an initial period of observation and identify prognostic factors. To describe the natural history of growing VS, identify prognostic factors, and review the most recent literature. Study Design Prospective cohort study and literature review. Setting Tertiary referral center. Patients Adult patients diagnosed with a VS between January 1998 and February 2023. Intervention Magnetic resonance imaging surveillance. Main Outcome Measure(s) Growth-free survival and subsequent growth-free survival considering significant growth as a change in size of ≥2 mm. Results Of 430 patients undergoing observation with serial magnetic resonance imaging, 193 (44.9%) demonstrated significant growth at a median of 1.6 years (interquartile range, 0.94–3.51). Of the 193 patients who presented an initial episode of growth, 137 elected to continue to be observed. Of those, 83 (60.6%) presented a second episode of growth at a median of 1.43 years (interquartile range, 1.00–2.49). The subsequent growth-free survival rates (95% confidence interval) at 1, 3, 5, 7, and 10 years were 91.79% (87.26–96.56%), 64.44% (56.56–73.42%), 52.52% (44.23–62.35%), 42.23% (33.92–52.56%), and 36.11% (27.89–46.76%), respectively. Univariate and multivariate Cox regression analyses showed that EC tumor location and initial growth rate were significant predictors of subsequent growth. Conclusions Close observation after documentation of growth is an appropriate management in well-selected cases given that only around 56% of the tumor will continue to grow. Extracanalicular tumor location and initial growth rate are promising prognostic factors to help determine which patient would be a better candidate for close surveillance after initial documentation of growth.

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Vestibular Schwannoma Management: Patient Perspectives and Health Literacy

Casazza,

Yancey,

Hunter

2024

Otology &Amp; Neurotology Open

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Objective: To assess medical decision-making, reasons for attrition, and health literacy among vestibular schwannoma (VS) patients last seen in clinic more than 2 years ago. Study Design: Survey. Setting: Tertiary skull base center. Patients: Adults with sporadic VS last evaluated more than 2 years ago. Methods: Survey including Brief Health Literacy Screen (BHLS), a validated 3-question measure of health literacy, and open-ended questions on care; retrospective chart review. Main Outcome Measures: BHLS score, patient reasons for attrition. Results: Of 1011 patients contacted, 205 (20.3%) patients responded and met all criteria for analysis. At initial evaluation, mean patient age was 50.6 ± 12.8 years, roughly half (51.4%) were female, and the majority (80.2%) identified as White. At the time of the survey, 48 (23%) continued to observe their tumor. The remaining 160 (76.9%) patients previously underwent treatment (surgery and/or radiation). Of those treated, 34 (21.3%) underwent intervention elsewhere. Symptoms since the last patient visit did not differ between observed and treated patients. About 94.7% of the cohort displayed high health literacy (BHLS > 9), though rates of inadequate health literacy were higher among observed patients (12.5% versus 3.1% in those treated). The most common reasons for opting not to follow-up included counseling issues, personal decisions, and social/life stressors (including the COVID-19 pandemic). Conclusions: Despite being a highly health-literate cohort, patients cited multiple reasons for attrition. Regardless of whether they were observed or treated, patients described follow-up visits as burdensome and perceived them to be of minimal benefit.

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Adherence to Long‐Term Follow‐up in Patients With Sporadic Vestibular Schwannomas Managed With Serial Observation

Cited by 3 publications

References 28 publications

Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

Documented Initial Growth Does Not Necessarily Indicate Treatment for Sporadic Vestibular Schwannomas

Vestibular Schwannoma Management: Patient Perspectives and Health Literacy

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