Symptom clusters in newly diagnosed glioma patients: which symptom clusters are independently associated with functioning and global health status?

Marijke B Coomans; Linda Dirven; Neil K Aaronson; Brigitta G Baumert; Martin Van Den Bent; Andrew Bottomley; Alba A Brandes; Olivier Chinot; Corneel Coens; Thierry Gorlia; Ulrich Herrlinger; Florence Keime-Guibert; Annika Malmström; Francesca Martinelli; Roger Stupp; Andrea Talacchi; Michael Weller; Wolfgang Wick; Jaap C Reijneveld; Martin J B Taphoorn

doi:10.1093/neuonc/noz118

Symptom clusters in newly diagnosed glioma patients: which symptom clusters are independently associated with functioning and global health status?

Neuro Oncol. 2019 Nov 4;21(11):1447-1457. doi: 10.1093/neuonc/noz118.

Authors

Marijke B Coomans¹, Linda Dirven^{1

2}, Neil K Aaronson³, Brigitta G Baumert^{4

5}, Martin Van Den Bent⁶, Andrew Bottomley⁷, Alba A Brandes⁸, Olivier Chinot⁹, Corneel Coens⁷, Thierry Gorlia¹⁰, Ulrich Herrlinger¹¹, Florence Keime-Guibert¹², Annika Malmström¹³, Francesca Martinelli⁷, Roger Stupp¹⁴, Andrea Talacchi¹⁵, Michael Weller¹⁶, Wolfgang Wick¹⁷, Jaap C Reijneveld¹⁸, Martin J B Taphoorn^{1

2}

Affiliations

¹ Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.
² Department of Neurology, Haaglanden Medical Center, Den Haag, Netherlands.
³ Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁴ Department of Radiation-Oncology, University Hospital Bonn, Bonn, Germany.
⁵ Department of Radiation Oncology (MAASTRO Clinic), and GROW (School for Oncology and Developmental Biology), Maastricht University Medical Center, Maastricht, Netherlands.
⁶ the Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, Netherlands.
⁷ Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
⁸ Department of Medical Oncology, Local Health Unit Company-Institute of Hospitalization and Scientific Care (Azienda USL-IRCCS), Institute of Neurological Sciences, Bologna, Italy.
⁹ Aix-Marseille University, Neurophysiopathology Institute, University Hospital Center Timone, Neuro-Oncology Service, Marseille, France.
¹⁰ European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium.
¹¹ Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany.
¹² Pitié-Salpetrière Hospital Group, Paris, France.
¹³ Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
¹⁴ Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁵ Department of Neurosciences, San Giovanni Addolorata Hospital, Rome, Italy.
¹⁶ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
¹⁷ Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany, and German Consortium of Translational Cancer Research, Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany.
¹⁸ Department of Neurology and Brain Tumour Center Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands.

Abstract

Background: Symptom management in glioma patients remains challenging, as patients suffer from various concurrently occurring symptoms. This study aimed to identify symptom clusters and examine the association between these symptom clusters and patients' functioning.

Methods: Data of the CODAGLIO project was used, including individual patient data from previously published international randomized controlled trials (RCTs) in glioma patients. Symptom prevalence and level of functioning were assessed with European Organisation for Research and Treatment of Cancer (EORTC) quality of life QLQ-C30 and QLQ-BN20 self-report questionnaires. Associations between symptoms were examined with Spearman correlation coefficients and partial correlation networks. Hierarchical cluster analyses were performed to identify symptom clusters. Multivariable regression analyses were performed to determine independent associations between the symptom clusters and functioning, adjusted for possible confounders.

Results: Included in the analysis were 4307 newly diagnosed glioma patients from 11 RCTs who completed the EORTC questionnaires before randomization. Many patients (44%) suffered from 5-10 symptoms simultaneously. Four symptom clusters were identified: a motor cluster, a fatigue cluster, a pain cluster, and a gastrointestinal/seizures/bladder control cluster. Having symptoms in the motor cluster was associated with decreased (≥10 points difference) physical, role, and social functioning (betas ranged from -11.3 to -15.9, all P < 0.001), independent of other factors. Similarly, having symptoms in the fatigue cluster was found to negatively influence role functioning (beta of -12.3, P < 0.001), independent of other factors.

Conclusions: Two symptom clusters, the fatigue and motor cluster, were frequently affected in glioma patients and were found to independently have a negative association with certain aspects of patients' functioning as measured with a self-report questionnaire.

Keywords: EORTC QLQ-C30; QLQ-BN20; glioma; health-related quality of life; symptom; symptom cluster.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Fatigue / etiology*
Fatigue / psychology
Female
Glioma / complications*
Global Health*
Health Status Indicators
Humans
Male
Middle Aged
Motor Activity*
Pain / etiology*
Pain / psychology
Palliative Care
Quality of Life*
Randomized Controlled Trials as Topic
Severity of Illness Index*
Surveys and Questionnaires
Symptom Assessment