Health-Related Quality of Life and its Determinants in Patients with Malignant Brain Tumors: A prospective longitudinal study

Purpose: The aim of this study was to evaluate the health-related quality of life (HRQoL) of malignant brain tumor (MBT) patients before surgery and to determine the change in HRQoL after surgery. Also, the prediction of independent factors associated with HRQoL after surgery was conducted. Methods: Patients diagnosed with BMT and admitted to Peking Union Medical College Hospital for surgery from May 2018 to August 2020 were included. Self-reported HRQoL questionnaires (EORTC QLQ-C30 and QLQ-BN20) were obtained before surgery and at seven days, one month, and three months after surgery. The Karnofsky Performance Scale (KPS) was assessed at the same time period. An online database was used to collect sociodemographic, oncologic history, and surgical information. Results: 140 patients were enrolled, while 98 patients were diagnosed with glioma and 42 patients were diagnosed with brain metastases (BM). 91.4% of patients (n=128) completed the 7-day postoperative assessment, 47.1% (n=66) completed the 1-month assessment, and 32.9% (n=46) completed the 3-month assessment. At the 7-day postoperative assessment, quality of life (QoL) had worsened significantly (P < 0.05) in terms of global health status, physical function, role function, fatigue, pain, and leg weakness, but remained stable at 1 month in patients with glioma. Seizure status improved significantly after surgery and was statistically significantly improved at 1 month compared to baseline (P < 0.05). Constipation and bladder control worsened after surgery. Skin pruritus worsened at 3 months postoperatively compared to preoperatively (P < 0.05). QoL of patients with BM was worse than baseline at 7 days after surgery for physical, role, and social function (P < 0.05). Fatigue, diarrhea, and leg weakness were worse than baseline at 7 days after surgery and recovered at 1 month (P < 0.05). One month after surgery, there were significant improvements in cognitive function, future uncertainty, and headache (P <0.05). The results of the multivariable linear regression showed that available sociodemographic, oncologic history, and surgical factors were important prognostic factors for different domains of QoL at different time periods. Conclusions: Patients with BMT who undergo surgery experience fluctuations in various dimensions of QoL in the early postoperative period, and one month after surgery is a key time point that can generally improve gradually. The tumor is located on the left side of the brain and the communication deficit is worse than on the right side. HRQoL can be identified through assessment, identification of QoL determinants, and consideration of interventions to improve patient QoL.