Systematic review of quality of life in the management of vestibular schwannoma

Gauden, Andrew J.; Weir, Philip; Hawthorne, Graeme; Kaye, Andrew H.

doi:10.1016/j.jocn.2011.05.009

Cited by 96 publications

(105 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5,14,19 Outcome assessment tools developed by the health care industry often evaluate a narrow range of technical outcomes and frequently fail to provide insight into how the disease itself or the untoward effects of treatment influence overall patient wellbeing. 2,9,26 With an increasing prevalence of small tumors in minimally symptomatic patients it is paramount that we carefully examine both traditional clinical measures and HRQOL data when determining best practices. 29,32 Previous studies evaluating HRQOL in VS have carried several notable limitations including low patient numbers, lack of a normal non-VS control population, exclusion of one or more treatment groups, and short-term follow-up and have therefore been criticized for being methodologically weak.…”

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.…”

mentioning

confidence: 99%

“…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. 9 The primary objective of the current study is to assess long-term health-related quality of life (HRQOL) in a large cohort of patients following observation, microsurgery, and SRS for small-to mediumsized VS using 3 multipurpose HRQOL questionnaires and 1 recently validated disease-specific instrument.…”

mentioning

confidence: 99%

“…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. 9 The primary objective of the current study is to assess long-term health-related quality of life (HRQOL) in a large cohort of patients following observation, microsurgery, and SRS for small-to mediumsized VS using 3 multipurpose HRQOL questionnaires and 1 recently validated disease-specific instrument.…”

mentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…11,27 Previous studies have demonstrated that among patients with sporadic VS, ongoing dizziness and headache are associated with the greatest health-related quality of life (HRQOL) reduction, whereas the contributions of unilateral hearing loss, tinnitus, and facial neuropathy are generally less by comparison. [2][3][4]22,26 Despite the substantial physical and emotional burden associated with headache in patients with VS, this condition remains understudied.…”

mentioning

confidence: 99%

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Carlson¹,

Tveiten

Driscoll³

et al. 2015

JNS

View full text Add to dashboard Cite

O ver the last 100 years, the treatment of vestibular schwannoma (VS) has undergone tremendous evolution. 32 With the increasing use of less invasive management methods including observation, stereotactic radiosurgery (SRS), or radiotherapy and subtotal or neartotal resection, incidences of disease-associated mortality, stroke, and permanent facial neuropathy have been substantially reduced. 12,27,32,41 obJect The primary goals of this study were: 1) to examine the influence of disease and treatment on headache in patients with sporadic vestibular schwannoma (VS); and 2) to identify clinical predictors of long-term headache disability.methods This was a cross-sectional observational study with international multicenter enrollment. Patients included those with primary sporadic < 3-cm VS and a separate group of general population control subjects without tumors. Interventions included a postal survey incorporating the Headache Disability Inventory (HDI), the Hospital Anxiety and Depression Scale, and a VS symptom questionnaire. The main outcome measures were univariate and multivariable associations with HDI total score. results The overall survey response rate was 79%. Data from 538 patients with VS were analyzed. The mean age at time of survey was 64 years, 56% of patients were female, and the average duration between treatment and survey was 7.7 years. Twenty-seven percent of patients received microsurgery, 46% stereotactic radiosurgery, and 28% observation. Patients with VS who were managed with observation were more than twice as likely to have severe headache disability compared with 103 control subjects without VS. When accounting for baseline differences, there was no statistically significant difference in HDI outcome between treatment modalities at time of survey. Similarly, among the microsurgery cohort, the long-term risk of severe headache disability was not different between surgical approaches. Multivariable regression demonstrated that younger age, greater anxiety and depression, and a preexisting diagnosis of headache were the primary predictors of severe long-term headache disability, while tumor size and treatment modality had little influence. coNclusioNs At a mean of almost 8 years following treatment, approximately half of patients with VS experience headaches of varying frequency and severity. Patient-driven factors including age, sex, mental health, and preexisting headache syndrome are the strongest predictors of long-term severe headache disability. Tumor size and treatment modality have less impact. These data may assist with patient counseling regarding long-term expectations following diagnosis and treatment.

show abstract