Quality of Life in Sporadic Vestibular Schwannoma: A Review

Gouveris, Haralampos; Mann, Wolf J.

doi:10.1159/000285182

Cited by 19 publications

(23 citation statements)

References 76 publications

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“…By default, the SF-36 has become the most widely used instrument for assessing HRQOL outcomes within the VS literature. 12 Importantly, the SF-36, GBI, and PROMIS-10 are multipurpose instruments and therefore are heavily influenced by patient comorbidity and may lack the sensitivity required to detect subtle changes after treatment or small differences between management arms. 4,9,11 In 2010 Shaffer and colleagues introduced the disease-specific PANQOL scale, a 26-item questionnaire evaluating facial function, balance, hearing, pain, anxiety, energy, and general health.…”

Section: Discussionmentioning

confidence: 99%

“…20 Within the last 20 years there has been growing interest within the medical community to develop methods for quantifying patient-perceived outcomes, understanding there is often disparity in what we as health care providers prioritize and what patients value. 2,9,12,26 Previous attempts to ascertain which treatment strategy ultimately provides the best quality of life for patients with small-to medium-sized VSs have been severely hampered by small numbers, short follow-up, potentially important selection biases, lack of a disease-specific quality of life analysis, and no nontumor control group for comparison. 9 After an extensive review of the recent literature, Gauden and colleagues concluded that since most studies have relied on the 36-Item Short Form Health Survey (SF-36) and have reported outcomes in disparate ways, no strong conclusion can be drawn regarding the merits of one treatment over another, and the existing literature suffers significantly from monomethod biases.…”

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confidence: 99%

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Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Carlson¹,

Tveiten²,

Driscoll

et al. 2015

JNS

183

178

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abbreviatioNs AAO-HNS = American Academy of Otolaryngology-Head and Neck Surgery; CPA = cerebellopontine angle; GBI = Glasgow Benefit Inventory; HRQOL = health-related quality of life; IQR = interquartile range; MCID = minimum clinically important difference; PANQOL = Penn Acoustic Neuroma Quality-of-Life; PROMIS-10 = 10-item Patient-Reported Outcomes Measurement Information System; SF-36 = 36-Item Short Form Health Survey; SRS = stereotactic radiosurgery; VS = vestibular schwannoma. submitted March 18, 2014. accepted November 11, 2014. iNclude wheN citiNg Published online January 2, 2015; DOI: 10.3171/2014.11.JNS14594. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Internal departmental funding was used without commercial sponsorship or support. obJect The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument. methods All patients with sporadic small- to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison. results A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures. coNclusioNs The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Carlson¹,

Tveiten²,

Driscoll

et al. 2015

JNS

183

178

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“…10,11 The few published prospective studies involved patients with small VSs (< 3 cm). 20,24,26 To our knowledge there is only one prospective report of QOL in patients with larger tumors (> 3 cm), and that study involved 37 patients.…”

Section: 25mentioning

confidence: 99%

Quality of life following surgery for large and giant vestibular schwannomas: a prospective study

Turel¹,

Thakar²,

Rajshekhar³

2015

JNS

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A discrepAncy between surgeon-assessed and patient-perceived outcomes of vestibular schwannoma (VS) surgery has been reported. 16,19,22 Hence, there is a need for greater emphasis on quality of life (QOL) outcomes (which are patient reported) following surgery for VS. Most of the QOL studies in patients undergoing surgery for VS are retrospective and include patients with small tumors. [1][2][3][4][5][6][7]14,18,21,23,27,28,31 Few studies have reported QOL following surgery for large VS, but even those have mostly been retrospective in nature. 22,25One of the major deficiencies in QOL studies on VS patients is the lack of a planned prospective comparison between QOL values before and after treatment in large cohorts of patients. 10,11 The few published prospective studies involved patients with small VSs (< 3 cm). 20,24,26 To our knowledge there is only one prospective report of QOL in patients with larger tumors (> 3 cm), and that study involved 37 patients. 8None of the reports of QOL in patients with VS have included the proportion of patients showing a minimum clinically important difference (MCID) in the different QOL domains. Surgeons need to know whether an observed change in score represents a clinically important improvement or deterioration rather than merely an inconsequential fluctuation. Differences in scores smaller than the MCID are considered unimportant, regardless of whether statistical significance is reached. To date, such information has not been provided in any published report on QOL in VS patients.We aimed to study the factors affecting QOL in pa- OBJect Prospective studies of quality of life (QOL) are infrequently performed in patients undergoing surgery for vestibular schwannoma (VS). The authors designed this to study to investigate health-related QOL (HR-QOL) in patients with large and giant VSs before and after surgery. methOdS Between January 2009 and December 2012, HR-QOL was measured prospectively before and after surgery, using the 36-Item Short Form Health Survey (SF-36), in 100 patients who underwent surgery for unilateral large or giant VS (tumor size ≥ 3 cm). The Glasgow Benefit Inventory (GBI) was also used to evaluate the effect of surgery. reSultS A total of 100 patients were included in the study (65 men and 35 women). Their mean age (± SD) was 44.2 ± 11.5 years. The preoperative QOL was decreased in all SF-36 domains. A 1-year follow-up evaluation was conducted for all patients (mean 13.5 ± 5.3 months after surgery). The results showed an improvement in HR-QOL compared with preoperative status in all cases, with 63%-85% of patients showing a minimum clinically important difference (MCID) in various domains. A second follow-up evaluation was performed in 51 cases (mean time after surgery, 29.0 ± 8.3 months) and showed sustained improvement in SF-36 scores. In some domains there was further improvement beyond the first follow-up. On the GBI, 87% of patients reported improvement, 1% felt no change, and 12% of patients reported deterioration. cONcluSiONS Patients harboring l...

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“…In patients presenting with profound hearing loss, comparative prospective studies have not found any statistically significant difference among those undergoing SRS and those undergoing microsurgery in terms of quality of life. 36 Whitmore et al 111 recently reported the results of a comprehensive quantitative, statistically driven study designed to determine which treatment modality yields the best quality of life at 5-and 10-year follow-up in patients with VSs smaller than 25 mm in diameter who present with some residual hearing. Even though the study was limited by the assumptions the authors had to make to come up with the best possible comparative model, it provided useful insights into treatment-related morbidity parameters and their influence on postoperative quality of life.…”

Section: Hypothetical Casementioning

confidence: 99%

An update on unilateral sporadic small vestibular schwannoma

Thakur¹,

Banerjee

Khan³

et al. 2012

FOC

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Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.

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Quality of Life in Sporadic Vestibular Schwannoma: A Review

Cited by 19 publications

References 76 publications

Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Quality of life following surgery for large and giant vestibular schwannomas: a prospective study

An update on unilateral sporadic small vestibular schwannoma

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