Clin-Symptom Management/Quality of Life

Abstract

INTRODUCTION: Recent trials have shown that the addition of procarbazine, lomustine, and vincristine (PCV) chemotherapy to radiotherapy (RT) improves survival in anaplastic oligodendroglioma. With improved survival, the quality of survival becomes pivotal. Because data regarding longterm functioning in anaplastic glioma patients are lacking, we evaluated cognitive functioning and health-related quality of life (HRQOL) in a cohort of Dutch and French long-term survivors from the European Organisation for Research and Treatment of Cancer (EORTC) trial 26951 on adjuvant PCV for anaplastic glioma. METHODS: Of the 28 Dutch patients and 9 French patients, 25 (89%) and 7 (78%), respectively, included in EORTC trial 26951 who were still alive agreed to participate. Cognitive functioning (assessed using neuropsychological tests for six cognitive domains) was compared with matched healthy controls. Patients' HRQOL (assessed with the EORTC QLQ-C30 and BN20 questionnaires) was compared with that of healthy controls, with the patients' own HRQOL 2.5 years following initial RT, and with the patient by proxy. Tumor histology, location, and recurrence; treatment; and the presence of epilepsy in the last year were recorded. RESULTS: The median survival time was 147 months. A total of 41% of patients did not have cognitive impairment, and 34% had severe impairment (≥ 4 domains affected). A total of 31% of patients were employed, 78% were independent in the activities of daily living. Patients' HRQOL was worse than controls' but was similar to 2.5 years after initial treatment. Treatment (in 35% of patients RT only, in 65% RT/PCV), histology and location were not correlated with cognition or HRQOL. Current epilepsy was associated with slower speed and poorer memory. Recent recurrence (13%) was associated with worse HRQOL. CONCLUSIONS: Cognitive functioning in longterm anaplastic glioma survivors is variable. However, most patients function independently. HRQOL is relatively stable during the course of the disease but is affected by recent recurrence. No effect of the addition of PCV to RT on cognition or on quality of survival could be identified in this patient group.