Abstract
PurposeFew studies have assessed fatigue in relation to glioma surgery. The purpose of this study was to explore the prevalence of pre- and postoperative high fatigue, perioperative changes, and factors associated with pre- and postoperative high fatigue in patients undergoing primary surgery for diffuse glioma.MethodsA total of 112 adult patients were prospectively included. Patient-reported fatigue was assessed before and one month after surgery using the cancer-specific European Organization for Research and Treatment of Cancer questionnaire fatigue subscale. The scores were dichotomized as high fatigue (≥ 39) or low fatigue (< 39). A change in score of ≥ 10 was considered as a clinically significant change. Factors associated with pre- and postoperative high fatigue were explored in multivariable regression analyses.ResultsHigh fatigue was reported by 45% of the patients preoperatively and by 42% of the patients postoperatively. Female gender and low Karnofsky Performance Status (KPS) were associated with preoperative high fatigue, while postoperative complications, low KPS and low-grade histopathology were associated with postoperative high fatigue. In total 35/92 (38%) patients reported a clinically significant improvement of fatigue scores after surgery, 36/92 (39%) patients reported a clinically significant worsening of fatigue scores after surgery, and 21/92 (23%) patients reported no clinically significant change in fatigue scores after surgery. Patients with low-grade gliomas more often reported low fatigue before surgery and high fatigue after surgery, while patients with high-grade gliomas more often reported high fatigue before surgery and low fatigue after surgery.ConclusionsOur findings indicate that fatigue is a common symptom in patients with diffuse glioma, both pre- and postoperatively. Perioperative changes were frequently seen. This is important knowledge when informing patients before and after surgery.
Highlights
Diffuse gliomas are the most common types of primary brain tumors [1]
Cancer patients indicate fatigue as one of the most troublesome symptom related to cancer and its treatment [9], and the symptom is common in glioma patients with an estimated prevalence of 36–82% [10,11,12,13,14]
We hypothesized that fatigue is a common symptom in the perioperative course and that the prevalence of fatigue may increase after surgery. The aims of this prospective study were (1) to explore the prevalence of pre- and postoperative high fatigue in patients undergoing primary surgery for diffuse glioma, (2) to investigate perioperative changes, and (3) to explore patient- and treatment-related factors associated with pre- and postoperative high fatigue
Summary
Diffuse gliomas are the most common types of primary brain tumors [1]. Due to their infiltrative growth pattern they cannot be cured [2], and the median survival is up to approximately 15 years for patients with low-grade glioma (LGG) [3] and 10–12 months for patients with high-grade glioma (HGG) [4, 5]. The incurable nature of diffuse gliomas makes preservation of quality of life a paramount factor to consider in treatment decision making. Intact neurological functions after surgery do not necessarily guarantee preservation of quality of life as more subtle and subjective symptoms may be. Cancer patients indicate fatigue as one of the most troublesome symptom related to cancer and its treatment [9], and the symptom is common in glioma patients with an estimated prevalence of 36–82% [10,11,12,13,14]
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