QOL-08PATIENT RELEVANT OUTCOMES IN RECURRENT GLIOBLASTOMA: A SYSTEMATIC LITERATURE REVIEW

Abstract

BACKGROUND: This study was designed to systematically identify and summarize findings from studies reporting quality of life (QoL), neurocognitive function (NCF), or overall survival (OS) in patients with recurrent glioblastoma. METHODS: English-language articles published between 01/2005 and 10/2014 were identified using EMBASE, MEDLINE, and the Cochrane Library. Data were extracted by two reviewers, with discrepancies resolved by consensus. RESULTS: Fifty publications reporting clinical outcomes were identified. Median OS ranged from 3.4–24.5 months across all study arms. Eight studies reported QoL or NCF outcomes in patients with recurrent glioblastoma. Patient-reported outcome assessments included measures of general health-related QoL (SF-36), general cancer-related QoL (FACT-G, EORTC QLQ-C30) and brain cancer-specific QoL (FACT-BR, EORTC QLQ-BN20); NCF instruments assessed learning, memory, attention, visuomotor function, mental flexibility, executive function, and lexical fluency (eg, Hopkins Verbal Learning Test-Revised, Trail-Making Test, Controlled Oral Word Association Test). Most studies included instruments validated for use in patients with brain cancer but not specifically tailored for glioblastoma. Baseline QoL and NCF among patients with recurrent glioblastoma were generally worse compared to both the general population and patients with other cancers. Treatments either had no impact on QoL or led to worse QoL. QoL was maintained after radiotherapy and alternating electric field therapy; targeted therapies, (ie, sunitinib, temozolomide, and lomustine) were associated with worse QoL, potentially due to treatment-related toxicities. No studies reported treatment benefits for NCF, however better tumor responses were associated with improved or stable NCF during treatment with bevacizumab +/- chemotherapy. Better measures of emotional and functional well-being were correlated with lower risks of progression and death, respectively. CONCLUSIONS: QoL and NCF are severely impaired in recurrent glioblastoma, reflecting aggressive disease progression and poor survival associated with this tumor. Novel treatment approaches are needed to improve survival and overall functioning.