The ability to return to work: a patient-centered outcome parameter following glioma surgery

Abstract

Background With refinements in diagnosis and therapy of gliomas, the importance of survival time as the sole outcome parameter has decreased, and patient-centered outcome parameters have gained interest. Pursuing a profession is an indispensable component of human happiness. The aim of this study was to analyze the professional outcomes besides their neuro-oncological and functional evaluation after surgery for gliomas in eloquent areas. Methods We assessed neuro-oncological and functional outcomes of patients with gliomas WHO grades II and III undergoing surgery between 2012 and 2018. All patients underwent routine follow-up and adjuvant treatment. Treatment and survival parameters were collected prospectively. Repercussions of the disease on the patients’ professional status, socio-economic situation, and neurocognitive function were evaluated retrospectively with questionnaires. Results We analyzed data of 58 patients with gliomas (WHO II: 9; III: 49). Median patient age was 35.8 years (range 21–63 years). Awake surgery techniques were applied in 32 patients (55.2%). Gross total and subtotal tumor resections were achieved in 33 (56.9%) and 17 (29.3%) patients, respectively, whereas in 8 patients (13.8%) resection had to remain partial. Most patients (n = 46; 79.3%) received adjuvant treatment. Median follow up was 43.8 months (range 11–82 months). After treatment 41 patients (70.7%) were able to resume a working life. Median time until returning to work was 8.0 months (range 0.2–22.0 months). To be younger than 40 at the time of the surgery was associated with a higher probability to return to work (p < .001). Multivariable regression analysis showed that patient age < 40 years as well as occupational group and self-reported fatigue were factors independently associated with the ability to return to work. Conclusion The ability to resume professional activities following brain tumor surgery is an important patient-oriented outcome parameter. We found that the majority of patients with gliomas were able to return to work following surgical and adjuvant treatment. Preservation of neurological function is of utmost relevance for individual patients´ quality of life.

Characteristics of Patients Returning to Work After Brain Tumor Surgery

“…This result is similar to those of other studies in which the percentage varies from 43 to 86% although it is calculated after a longer period from surgery (Kalkanis et al, 2000;Akagami et al, 2002;Krupp et al, 2009;Schepers et al, 2018;Thurin et al, 2019). In the glioma group, 31% of patients returned to work, and this percentage is lower than in studies on low-grade glioma or mixed diagnosis (Mandonnet et al, 2015;Muto et al, 2018;Ng et al, 2019;Senft et al, 2020;Yoshida et al, 2020) but very similar to other studies on patients with glioblastoma (Gzell et al, 2014;Starnoni et al, 2018), and this result could be explained by the higher rate of high-grade glioma in our sample (75.9%). Among people returning to work, most patients with glioma and fewer than half of patients with meningioma changed their working tasks and reduced working time.…”

“…Differently from our study, Starnoni et al report a lower preoperative KPS scores in patients with glioblastoma not returning to work at a follow-up of 6 months (78.5 vs. 85.1) (Starnoni et al, 2018 ); Muto et al find a lower median postoperative KPS in patients with low-grade glioma unable to work at a follow-up of 6.9 months (90 vs. 100) (Muto et al, 2018 ); and Yoshida et al report high preoperative general memory scores among the predictive factors of the return to work at 1 year after surgery (Yoshida et al, 2020 ). In our study, the professional category was not associated with return to work, but conflicting results exist in the literature on the influence of these variables (Starnoni et al, 2018 ; Ng et al, 2019 ; Senft et al, 2020 ; Yoshida et al, 2020 ). Emotional distress was also not significantly associated with going back to work even if we can observe worse scores in patients with glioma who did not return to work.…”

“…Most of the studies in the literature did not use PROMs, but investigated only socio-demographic and clinical variables as potentially associated with employment status after surgery. Similarly to us, Senft et al do not find any association between preoperative KPS score and return to work or between postoperative treatments and return to work in patients with glioma (Senft et al, 2020). Differently from our study, Starnoni et al report a lower preoperative KPS scores in patients with glioblastoma not returning to work at a follow-up of 6 months (78.5 vs. 85.1) (Starnoni et al, 2018); Muto et al find a lower median postoperative KPS in patients with low-grade glioma unable to work at a follow-up of 6.9 months (90 vs. 100) (Muto et al, 2018); and Yoshida et al report high preoperative general memory scores among the predictive factors of the return to work at 1 year after surgery (Yoshida et al, 2020).…”

“…In particular, the TMT test seems to be the most sensitive, probably because it requests multiple cognitive processes involving mental flexibility and multitasking skills. The 3 month follow-up is probably too early for patients with glioma who tend to return to work after a longer period of time (Senft et al, 2020 ). Moreover, the group of patients with glioma is composed of both grade I/II and grade III/IV glioma that have different prognoses, and consequently, future studies on larger samples should consider these pathologies separately.…”

Functional outcome and quality of life after meningioma surgery: a systematic review

“…Contrasting the subjective reporting of HrQoL and FD, return to work (RTW) seems more pragmatic, has been used for several neurosurgical pathologies 50‐53 and could be an indicator of the long‐term functional recovery in meningioma patients 26 . However, socioeconomic factors may induce bias 54,55 and heterogeneous social system and financial compensations among countries may cause disparities and decrease the validity of RTW as an objective assessment of HrQoL and FD.…”