Illness intrusiveness and subjective well-being in patients with glioblastoma multiforme.

Abstract

2063 Background: Glioblastoma multiforme (GBM) is the most common adult CNS malignancy. The quality-of-life (QOL) impact of its neurological sequelae and poor prognosis is poorly understood. In this study we examined relations between disease severity and mood in GBM patients. Methods: GBM patients (n=73) completed validated questionnaires examining depression (CESD), positive affect (ABS), illness intrusiveness (II), and health-related QOL (EORTC-QLQ30, BN-20). Median age was 53 years (range 26-75), median time since diagnosis was 1.1 years (range 0.1-12.4). 88% were on temozolomide. Questionnaire scores were compared to normative data from GI, GU, Breast, Head and Neck, Lymphoma, and Lung cancer groups using t-tests. Hierarchical multiple regression analyses tested the impact of disease severity indicators (ECOG; Symptoms, derived from QLQ30, BN20) and potential moderators on mood and whether II mediates those effects. Results: GBM patients reported less positive affect, more depression and greater II than other cancer patients (p<.05). Increase in symptoms correlated with greater II (β=.59; 95% CI [.31, .87], p<.0001) and depression (β=.37; 95% CI [.20, .55], p<.0001) and less positive affect (β=-.04; 95% CI [-.08, -.01], p=.02). Surprisingly, higher ECOG (i.e., poorer performance status) was associated with less II (β=-3.58; 95%CI [-7.06, -.10], p=.04) and depression (β=-2.20; 95%CI [-4.21, -.19], p=.03). II partially mediated the relations between disease severity and mood, evidenced by the change in the disease severity coefficient when II was added to the models (mean change measured by bootstrap sampling: CESD=.23, 95% CI [.06, .43]; ABS=.21, 95%CI [.02, .44]). The occurrence of other stressful life events was associated with II (β=2.73; 95% CI [.43, 5.02], p=.02), but there was no evidence of a moderating effect on this or any other relationship (p>.05). Conclusions: GBM patients are more distressed than other cancer patients. GBM-induced lifestyle disruptions partially mediate the association between disease severity and subjective well-being. Efforts to engage patients in valued activities and interests, despite the constraints, can help to preserve QOL.