Effect of disease burden on health-related quality of life in patients with malignant gliomas

The burden imposed by disease recurrence in patients with high-grade gliomas is not well documented.We studied the frequency of self-report symptoms and the effects on health-related quality of life in patients who had recurrent glioblastoma multiforme or anaplastic astrocytoma and who had a Karnofsky performance score 70.Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Items (QLQ-C30) and the Brain Cancer Module (BCM20) before initiation of treatment for rst recurrence of disease.Six symptoms (fatigue, uncertainty about the future, motor dif culties, drowsiness, communication difculties, and headache) were reported with a frequency >50% by both groups of patients.An additional two symptoms (visual problems and pain) were also reported with frequencies of >50% by patients with recurrent glioblastoma multiforme.Most of the symptoms were likely due to recurrence, but previous radiation therapy and on-going corticosteroid treatment may have also been casual factors for fatigue, whereas uncertainty about the future and pain were probably nonspeci c for brain cancer.Problems with motor functioning, vision, leg strength, and pain were reported more frequently by patients with recurrent glioblastoma multiforme than by those with recurrent anaplastic astrocytoma.Scores on health-related quality-of-life functioning scales were similar in the two groups.Finally, the scores for patients who had recurrent high-grade gliomas and a Karnofsky performance score 70 were compared with the reported health-related quality of life scores of patients with other cancers.Their scores were similar to those of patients with metastatic cancers and worse than those of patients with localized cancers.Neuro-Oncology 2, 221-228, 2000 (Posted to Neuro-Oncology [serial online], Doc.99-055, September 15, 2000.URL <neuro-oncology.mc.duke.edu>)P rimary brain cancer is a relatively infrequent disease.It was projected that it will be diagnosed in about 16,500 people in the USA compared with an estimated diagnosis of 184,200 new breast cancer cases and an overall 1,220,100 new cancer cases in 1999 (American Cancer Society, 2000;Landis et al., 1999).However, the mortality rate in brain cancer is high and, in 2000, about 13,000 of patients will die from it compared with an estimated mortality of 41,200 for breast cancer.It accounts for one-quarter of all childhood cancers and, after leukemia, is the second leading cause of cancer deaths among children.Of the primary malignant brain cancers, 60% are malignant gliomas (Levin et al., 1997).These vary from well-differentiated astrocytomas (grades I and II) comprising 15% to 20% of all malignant gliomas, through AAs 3 and oligoastrocytomas (grade III) comprising 30% to 35%, to GBMs (grade IV), which represent 40% to 50% of all malignant gliomas.Thus, high-grade gliomas (grades III and IV) comprise the majority (80%-85%) of all primary brain cancer, with an incidence of about 13,500 to 14,500 per year in the USA.