Dynamics in cognition and health-related quality of life in grade 2 and 3 gliomas after surgery

Abstract

Background The focus of clinical management and research in gliomas has been on survival, but the interest in the treatment effects on cognition and health-related quality of life (HRQoL) is emerging. The primary aim of this study was to investigate the dynamics in cognition after brain tumor surgery for astrocytomas and oligodendrogliomas grade 2 and 3. The secondary aim was to investigate the association of postoperative changes in cognition with changes HRQoL. Methods In this observational study, 48 patients operated for an astrocytoma or oligodendrogliomas, grade 2 or 3, at the Department of Neurosurgery, Uppsala, Sweden, 2016–2021, were included. Cognitive and language skills were assessed with a selected test battery and HRQoL was patient-reported as assessed with RAND-36 pre- and approximately 3 months postoperatively. Results There was a significant postoperative decrease in attention span and verbal learning, but the patients improved in the test for visual memory. There was no change in visual attention, executive function, verbal memory, visual organization and construction, verbal fluency, and confrontation naming. The RAND-36 variables physical function, role physical, general health, vitality, and social functioning decreased significantly after surgery. Patients operated for tumor recurrence exhibited greater deterioration in attention and a greater extent of resection correlated with a less pronounced decrease in verbal memory, but there were otherwise weak associations between the dynamics in cognition and patient-, tumor-, and treatment-variables. A decline in cognitive variables was not associated with worse HRQoL. Conclusions Although both several cognitive and HRQoL domains deteriorated postoperatively, these changes did not correlate with each other. This highlights the complexity of cognitive and HRQoL dynamics in the early postoperative phase.

Qualitative and Visual Along-Tract Analysis of Diffusion-Based Parameters in Patients with Diffuse Gliomas

“…Summary of the population demographics, diagnoses and radiological features is displayed in Table 1 . In eleven patients, the tumor was considered eloquent as it involved the minimal common brain as previously described [ 8 , 59 ]. Tumor resection was performed in all patients; resection was performed in the awake condition in six patients and in the asleep condition in eight patients (two patients underwent neurophysiological monitoring).…”

Quality of life after surgery for lower grade gliomas

“…LGGs are characteristically slow growing, with extended survival compared to other malignant brain tumors, and typically present in the second through fourth decades of life in otherwise healthy individuals 3 . Although less aggressive than their high‐grade counterparts, these tumors are associated with neurologic and systemic symptoms and a diminished quality of life (QOL) 4–20 . These negative effects are attributed to both natural disease progression as well as treatment, 21–26 which typically consists of maximal safe surgical resection followed at some point by radiation, chemotherapy, or a combination of the two.…”

“…3 Although less aggressive than their high-grade counterparts, these tumors are associated with neurologic and systemic symptoms and a diminished quality of life (QOL). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] These negative effects are attributed to both natural disease progression as well as treatment, [21][22][23][24][25][26] which typically consists of maximal safe surgical resection followed at some point by radiation, chemotherapy, or a combination of the two. Despite the clinical significance of maintaining levels of functioning and QOL in a relatively young patient population, few studies have investigated these outcomes exclusively for individuals diagnosed with LGG, with most focusing on higher grade tumors or including LGG as a small subset.…”

Understanding language and cognition after brain surgery – Tumour grade, fine‐grained assessment tools and, most of all, individualized approach

“…Language and cognition have been widely described as key factors of brain tumour patients' quality of life and survival (Rimmer et al, 2023; Salans et al, 2021). Within cognition, better performance in executive functioning, processing speed, working memory (Boele et al, 2014), and divided attention (Svedung Wettervik et al, 2022) have been associated with better health‐related quality of life. Thus, the daily life independence of patients with brain tumours is mainly supported by a maximally preserved language and cognitive function (Bergo et al, 2016).…”