Artikel
Clinical measurement concepts for quality of life in brain tumour patients with motor-eloquent lesions
Klinische Messkonzepte für Lebensqualität bei Hirntumorpatienten mit motor-eloquenten Tumoren
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Autoren
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Anna L. Roethe
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Humboldt-Universität zu Berlin, Image Knowledge Gestaltung – An Interdisciplinary Laboratory, Berlin, Deutschland
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Denny Chakkalakal
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Humboldt-Universität zu Berlin, Image Knowledge Gestaltung – An Interdisciplinary Laboratory, Berlin, Deutschland
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Mandy Kilias
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Anne Letsch
- Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Berlin, Deutschland
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Martin Misch
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Thomas Picht
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland; Humboldt-Universität zu Berlin, Image Knowledge Gestaltung – An Interdisciplinary Laboratory, Berlin, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Dedicated measuring instruments for health-related quality of life (HrQoL) gain importance in doctor-patient communication and multiprofessional care teams. However, HrQoL in diagnosis and treatment of brain tumor patients is still routinely screened by clinical scores such as Karnofsky Performance Index (KPI) and clinical neurological status. There is little published experience on the patient-reported Short-Form Health Survey (SF-12) for follow-up screening in brain tumor patients. This study investigates the meaningfulness and added clinical impact of SF-12 in suspected motor-eloquent brain lesions.
Methods: We analyzed prospective data of 85 patients who underwent brain surgery for perirolandic (M1, S1) or insular lesions. KPI, functional neurological status using the National Institutes of Health Stroke Scale (NIHSS) plus physical and mental health composite scales (PCS/MCS) of SF-12v1 have been documented preoperatively (T1) and after 3 (T5), 6 (T6) and 12 (T7) months. The data has also been correlated with histopathology and tumor location.
Results: Mean patient age was 53,2 (±16; 20-87) with a m/f ratio of 1,36:1. Pathologies included 44,7% HGG, 23,5% metastasis, 12,9% LGG, 7,1% cavernoma, 3,5% meningioma, 3,5% AVM, 4,7% other. 15,3% of cases were recurrences. NIHSS as indicator for symptom burden and PCS as indicator for physical health had a significant correlation in T1 (r=-0,44, p=0,002) and T5 (r=-0,48, p=0,007) assessments; in the histopathology subgroup analysis, NIHSS and PCS had also a significant correlation for HGG at T5 (r=-0,67, p=0,023). Mean PCS was lowest in M1 tumors (35,3±10,4 in T1; 37,8±11,2 in T5). NIHSS and MCS as indicator for mental health showed a significant correlation in T1 (r=-0,41, p=0,005), T5 (r=-0,36, p=0,044) and T7 (r=-0,71, p=0,031) assessments, yet frequent discrepancies in subgroups HGG and LGG. Mean MCS was lowest in metastases (40,0±12,3 in T1; 41,6±11,2 in T5).
Conclusion: In neurooncology, HrQoL directly correlates with preservation of cognitive and neurological function. Across different therapeutic settings, patient-reported outcomes may support postop screening for physical and/or mental burden caused by the disease and help identify discrepancies between external evaluation and self-assessment. Particularly SF-12 MCS should be considered as additional parameter for functional outcome measurements as it can provide patient-specific information on disease and treatment experience.
