gms | German Medical Science

Objective: The impact of surgery and radiochemotherapy for primary and recurrent glioblastoma (pGBM and rGBM) on quality of life (QoL) is still unclear. Since QoL is an essential endpoint of therapy, we evaluated QoL in adult patients with pGBM and rGBM and compared QoL scores of younger and elderly patients.

Method: Inclusion criteria for this single centre, prospective study were: surgical resection of GBM at first diagnosis followed by standard adjuvant radio-chemotherapy and histological or radiological confirmed first recurrence. For primary and recurrent surgery, pre-op, early post-op and 3 months(m) post-op evaluation of QoL using the EORTC questionnaire (QLQ-C30) and QLQ-Brain Cancer Modules (QLQ-BN20) was performed. At the same time points NIHSS and KPS were evaluated.

Results: For pGBM 39 pre-op, 28 post-op and 47 QoL questionnaires 3 m post-op were available. For rGBM, we collected 34 pre-op, 30 post-op and 24 QoL questionnaires 3m post-op. Median physical functioning scores decreased from pre Op to 3 m post Op in the primary setting as well as at recurrence. Median fatigue scores increased from pre Op to 3m post Op at primary diagnosis. Median overall quality of life scores decreased from pre to post Op and increased from post Op to 3 m post Op in both settings. Median motor dysfunction scores did not increase after surgery as well as median communication deficit scores. Median scores for emotional functioning and global health status were nearly stable. Significant differences were found in comparison between elderly and younger patients regarding global health status (p=.046) and overall quality of life (p=.032) 3 m post-op at primary diagnosis. There was only minor deterioration regarding median NIHSS and median KPS after surgery and at recurrence. There were no significant differences between elderly and younger patients regarding NIHSS and KPS for the investigated time points except for KPS pre-op (p=.013) and post-op (p=.048) in the recurrent setting.

Conclusions: We found a trend of decreased functional scores and increased symptom scores in the recurrent setting as well as a trend of reduced QoL in the elder patients. Objective clinical evaluation and subjective symptom evaluation were not always congruent. We therefore recommend to exert more efforts in assessment of QoL with subsequent psycho-oncological support and consider the reduced physical ability of elderly patients.