Quality of life in patients with intracranial tumors: does tumor laterality matter?

Abstract

OBJECTIVE Traditionally, the dominant (usually left) cerebral hemisphere is regarded as the more important one, and everyday clinical decisions are influenced by this view. However, reported results on the impact of lesion laterality are inconsistent in the scarce literature on quality of life (QOL) in patients with brain tumors. The authors aimed to study which cerebral hemisphere is the most important to patients with intracranial tumors with respect to health-related QOL (HRQOL). METHODS Two hundred forty-eight patients with unilateral, unifocal gliomas or meningiomas scheduled for primary surgery were included in this prospective cohort study. Generic HRQOL was measured using the EQ-5D-3L questionnaire preoperatively and after 4-6 weeks. Cross-sectional and longitudinal analyses of data were performed. RESULTS Tumor volumes were significantly larger in right-sided tumors at diagnosis, and language or speech problems were more common in left-sided lesions. Otherwise, no differences existed in baseline data. The median EQ-5D-3L index was 0.73 (range -0.24 to 1.00) in patients with right-sided tumors and 0.76 (range -0.48 to 1.00) in patients with left-sided tumors (p = 0.709). Due to the difference in tumor volumes at baseline, histopathology and tumor volumes were matched in 198 patients. EQ-5D-3L index scores in this 1:1 matched analysis were 0.74 (range -0.7 to 1.00) for patients with right-sided and 0.76 (range -0.48 to 1.00) for left-sided lesions (p = 0.342). In the analysis of longitudinal data, no association was found between tumor laterality and postoperative EQ-5D-3L index scores (p = 0.957) or clinically significant change in HRQOL following surgery (p = 0.793). CONCLUSIONS In an overall patient-reported QOL perspective, tumor laterality does not appear to be of significant importance for generic HRQOL in patients with intracranial tumors. This may imply that right-sided cerebral functions are underestimated by clinicians.

Quality of life after surgery for intracranial meningioma

“…Our symptom frequency results differed from what to the best of our knowledge was the only prior study that examined laterally, in which patients with tumors of the left brain reported a higher symptomology 8 ; it is difficult to compare the 2 results given that the prior study included only 29 cases. A more recent study found no association between tumor laterality and QOL, 12 and suggested that clinicians underestimate the importance of the right brain.…”

“…To the best of our knowledge, the current study is the largest study to date to examine health‐related QOL for patients with meningioma, being 10‐fold larger than prior reports . The current study benefits from a large, population‐based sample of patients and controls .…”

“…To the best of our knowledge, the current study is the largest study to date to examine health-related QOL for patients with meningioma, being 10-fold larger than prior reports. [6][7][8][9][10][11][12][13] The current study benefits from a large, population-based sample of patients and controls. 14 The instruments used in the current study (SF-36) have been validated previously and have population norms.…”

“…15 The results of the current study identified statistically lower scores for cases compared with controls in 7 of the 8 SF-36 domains. Prior studies (Table 4), [6][7][8][9][10][11][12][13] using both the SF-36 as well as other QOL instruments, have reported a variety of case/control differences; one study found no significant differences in QOL between cases and controls, 9 whereas later studies found significant differences with regard to General Health and Vitality 13 and Physical Role. 10 Of note, the 2013 case-control study performed by van Nieuwenhuizen et al 13 found case scores to be lower than control scores in all 8 SF-36 domains, but the majority of differences were not statistically significant because of the small sample size (21 cases).…”

“…[3][4][5] Despite this, to the best of our knowledge only a few studies to date, all of which included relatively small numbers of patients, have explicitly examined QOL among patients with meningioma. [6][7][8][9][10][11][12][13] As the use of imaging has increased throughout the United States, so too has the number of individuals diagnosed with meningioma, with up to 1% of the general adult population estimated to have such a lesion, 1 although many of those patients will remain asymptomatic. For those patients who present with symptoms or with brain imaging that is clinically concerning, surgical resection remains the most commonly selected intervention, with a much smaller number of patients undergoing radiotherapy as their first course of treatment.…”