P15.10 * COGNITIVE AND FUNCTIONAL STATUS OF PATIENTS AND QUALITY OF LIFE OF CAREGIVERS: A PROSPECTIVE STUDY IN A COHORT OF RECURRENT GLIOBLASTOMAS

Abstract

INTRODUCTION: The diagnosis and treatment of brain tumors are often associated with physical, emotional and social wellness interruption and represent a life-changing event for patients and their families. High levels of psychological distress were found among patients and caregivers; conversely, social support has been identified as a powerful factor increasing life satisfaction of caregivers. Therefore, the primary purpose of this prospective study was to assess the relationships between cognitive and functional status of patients with recurrent glioblastoma receiving intravenous chemotherapy (bevacizumab and fotemustine) and quality of life of caregivers. Secondly, we analyzed changes in cognitive, functional and emotional status during the study period. PATIENTS AND METHODS: All couples patient/caregiver were evaluated 3 times during the assessment period (T0: before the start of chemotherapy; T1: 3 months later; T2: 6 months later). Each patient was assessed by the Mini Mental State Examination (MMSE) and Karnofsky Performance Status (KPS) to estimate cognitive and functional status. To investigate depression, anxiety and quality of life of caregivers we used the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A) and the Caregiver Quality of Life Cancer Scale (CQLCS). RESULTS: Thirty-five patients (17 M, 18 F; mean age = 53,74 ± 9,71) and thirty-five caregivers (15M, 20F; mean age = 52,54 ± 12,70) initially participated into the study, but thirty pairs only completed all assessments; as for the five patients who dropped out, two stopped chemotherapy due to myelotoxicity and three patients died for tumor progression. After regression analysis - including CQLCS score at baseline, HAM-A, HAM-D, MMSE and KPS scores and the response to treatment - quality of life of caregivers at T1 was significantly determined by CQLCS score at T0 (p = 0,001) and MMSE score at T1 (p = 0,011), while at T2 was determined by KPS score at T2 (p = 0,01). Furthermore, we found that scores obtained at MMSE and KPS declined during the evaluation period, as well as HAM-D and CQLCS, while HAM-A didn't change significantly. CONCLUSIONS: These data suggest that quality of life of caregivers after 3 months from the start of chemotherapy primarily are influenced by the initial quality of life and cognitive status of the patient, while after 6 months it depends on the functional status of the patient. One can hypothesize that cognitive decline of the patient has a strong impact on quality of life of caregiver only initially as at a later stage it is hidden by the functional status worsening. Anxiety changes during the evaluation period seem less important that the severity of anxiety in the early stage of the disease.