Postoperative Deterioration in Health Related Quality of Life as Predictor for Survival in Patients with Glioblastoma: A Prospective Study

Abstract

BackgroundStudies indicate that acquired deficits negatively affect patients' self-reported health related quality of life (HRQOL) and survival, but the impact of HRQOL deterioration after surgery on survival has not been explored.ObjectiveAssess if change in HRQOL after surgery is a predictor for survival in patients with glioblastoma.MethodsSixty-one patients with glioblastoma were included. The majority of patients (n = 56, 91.8%) were operated using a neuronavigation system which utilizes 3D preoperative MRI and updated intraoperative 3D ultrasound volumes to guide resection. HRQOL was assessed using EuroQol 5D (EQ-5D), a generic instrument. HRQOL data were collected 1–3 days preoperatively and after 6 weeks. The mean change in EQ-5D index was −0.05 (95% CI −0.15–0.05) 6 weeks after surgery (p = 0.285). There were 30 patients (49.2%) reporting deterioration 6 weeks after surgery. In a Cox multivariate survival analysis we evaluated deterioration in HRQOL after surgery together with established risk factors (age, preoperative condition, radiotherapy, temozolomide and extent of resection).ResultsThere were significant independent associations between survival and use of temozolomide (HR 0.30, p = 0.019), radiotherapy (HR 0.26, p = 0.030), and deterioration in HRQOL after surgery (HR 2.02, p = 0.045). Inclusion of surgically acquired deficits in the model did not alter the conclusion.ConclusionEarly deterioration in HRQOL after surgery is independently and markedly associated with impaired survival in patients with glioblastoma. Deterioration in patient reported HRQOL after surgery is a meaningful outcome in surgical neuro-oncology, as the measure reflects both the burden of symptoms and treatment hazards and is linked to overall survival.

Quality of survival the 1st year with glioblastoma: a longitudinal study of patient-reported quality of life

“…We have previously demonstrated that early deterioration in HRQoL following surgery is independently and markedly associated with impaired survival, 16 and the same tendencies are seen in the present study. The rapid decline seen in some patients is seemingly not always due to perioperative complications, surgically induced deficits, or suboptimal extents of resection.…”

“…By including even short-term HRQoL dynamics (e.g., the time before surgery to end of radiotherapy) rather than a single static measure, more precise information may be achieved since early changes in HRQoL may reflect the aggressiveness of the disease. This was suggested by our previous study, 16 and is confirmed in this study, where patients with early progressive deterioration after surgery had a substantially shorter survival. This is further supported by Bosma et al 3 who compared HRQoL in short-term and long-term survivors and found a deterioration in HRQoL in short-term survivals between baseline (after surgery, before radiotherapy) and 4 month follow-up, whereas the long-term survivors experienced improved HRQoL.…”

“…16 However, it is largely unknown how potentially important factors such as recovery of transient deficits, progression of disease, adverse effect of adjuvant therapy, or other significant medical events influence the HRQoL beyond the immediate postoperative period and during the course of the disease. In the present study, we focus on longitudinal patient-reported HRQoL with serial assessments from before primary surgery and up to 12 months after surgery.…”

Editorial: Patient validation of retrospective data

“…It has been well shown that adverse events are typically higher in randomized controlled trials (RCTs), where specific efforts are made to document outcomes, than in retrospective case series. 3,6 This study demonstrates the unreliability of such retrospective reviews and calls for validated measures of neurosurgical morbidity.…”

“…Patient-reported outcomes at specified time points could be another step toward reducing assessment bias and emphasizing outcomes that are relevant to the patients themselves. 6,12 Assessing quality of life or quality of survival in brain operations that are essentially palliative in nature may, for example, be more relevant than extent of resection. Still, patient-reported outcomes are more demanding and call for standardized follow-up of patients instead of retrospective review of medical records.…”