Care For Glioma Patients Research Articles

Patient-derived glioma organoids real time identification of IDH mutation, 1p/19q-codeletion and CDKN2A/B homozygous deletion with differential ion mobility spectrometry.

Extent of brain tumor resection continues to be one of the central decisions taken during standard of care in glioma patients. Here, we aimed to evaluate the most essential molecular factors, such as IDH (isocitrate dehydrogenase) mutation in gliomas classification with patient-derived glioma organoids (PGOs) using differential mobility spectrometry (DMS). we prospectively recruited 12 glioma patients, 6 IDH-mutated and 6 IDH wild-type tumors, from which PGOs were generated ex-vivo. Altogether, 320 PGOs DMS spectra were analyzed with a classifier algorithm based on linear discriminant analysis (LDA). LDA model classification accuracy (CA) obtained between IDH-mutant and IDH wild-type PGOs was 90% (91% sensitivity and 89% specificity). Furthermore, 1p/19q codeletion classification within IDH mutant PGOs reached 98% CA (93% sensitivity and 99% specificity), while CDKN2A/B homozygous loss status had 86% CA (63% sensitivity 93% specificity). DMS suitability to differentiate IDH-mutated PGOs was thus validated in ex vivo cultured samples, PGOs. Preliminary results regarding 1p/19q codeleted PGOs and CDKN2A/B loss PGOs identification endorse testing in a prospective intraoperative glioma patient cohort. Our results reveal a sample classification set-up that is compatible with real-time intraoperative surgery guidance.

Use of complementary therapies and supportive measures of patients with intracranial gliomas—a prospective evaluation in an outpatient clinic

PurposePatients with intracranial gliomas frequently seek for complementary and alternative medicine (CAM), in addition to guideline-directed therapy. In this study, we therefore assessed patients’ information needs regarding treatment and support, and evaluated their attitudes toward experimental trials and alternative therapies.MethodsA prospective, cross-sectional, descriptive survey was conducted in our center. We developed an interview focusing on how patients obtain further information about therapy and the use of alternative/complementary therapies.ResultsA total of 102 patients participated in the survey. 50% (n = 51) of patients reported that they had not attempted any additional therapies. When patients attempted self-therapy, it was most commonly in the areas of nutrition (25%, n = 26) and dietary supplements (17%, n = 17). Alternative or complementary therapies were used by 14% (n = 14) of the patients. Younger age (Odds ratio (OR) 0.96 (95% Confidence interval (CI) 0.92–0.99, p = 0.012) and tumor entity (OR 5.01 (95% CI 1.66–15.11, p = 0.004) for grade 4 vs. 3 tumors and OR 7.22 (95% CI 1.99–26.28) for grade 4 vs. other tumors p = 0.003) were significantly associated with a greater interest in CAM.ConclusionsInterest in complementary and alternative medicine, as well as nutrition and dietary supplements is high (51%) among glioma patients, and significantly higher among younger patients and those with a worse diagnosis (WHO grade 4). A comprehensive approach to information, including paramedical topics, is needed to provide optimal patient counseling and care for glioma patients.

Health professional involvement in the formulation of research questions: findings from the Italian guideline on palliative care in adults with glioma.

In 2017, the European Association of Neuro-Oncology (EANO)published the guideline for palliative care in adults with glioma. The Italian Society of Neurology (SIN), the Italian Society for Palliative Care (SICP), and the Italian Association for Neuro-Oncology (AINO) joined forces to update the guideline, and adapt it to the Italian context. We involved patients, caregivers, and (herein presented) healthcare professionals (HPs) in the formulation of the guideline clinical questions. Online survey of Italian HPs experienced in the care of patients with glioma. Participants rated the importance of 14 pre-specified intervention topics on a 0/10 scale and gave their free comments. Of 244 participants, 149 (61%) were palliative medicine (PM) HPs and 95 Neuro HPs. Their mean age was 48.9years, 63% were women, and 48% had over 12years of experience in the care of glioma patients. Physicians were 68%, followed by nurses (28%), psychologists (7%), therapists (3%), and social workers (2%). Most HPs rated the pre-specified topics as important (score ≥ 7) or critical (score ≥ 9), with some differences between PM and Neuro HP groups. There were 58 free comments: 46 (78%) on nine pre-specified topics, and 13 on four new topics, three of which were guideline-pertinent ("caregiver's support and education"; "family physician's training in neuro-oncology"; and "PM HPs' training in neuro-oncology"). Participation in the survey was high and information-rich, between-group rating differences reflecting HP background. Participants endorsed the 14 intervention topics devised by the guideline panel and identified three additional topics.

P08.03.A Conversation tool for brain tumor patients - tailor-made support and guidance for the patient and their proxies

Abstract Background An evaluation by the Dutch Neuro-Oncology Society (LWNO) showed that screening for psychosocial problems and the need for psychosocial care in glioma patients and their proxies is currently not optimal. Although tools to screen for psychosocial issues such as the Distress Thermometer exist, in daily practice they appear to be insufficient to discuss all disease-specific problems patients with brain tumors may encounter. We describe the development of a conversation tool to support the consultation between the patient with a brain tumor, their proxies and the health care professionals (HCPs). Material and Methods The development of the conversation tool for brain tumors was based on the tool used by the AYA Care Network in the Netherlands. Topics of importance for the entire care process were identified in a brainstorming session with 15 people (comprising HCPs, patients and proxies). Subsequently, the content of the conversation tool was determined by members of the LWNO and members of the LWNO-working group of nurses specialized in neuro-oncology (LWNO-v). Each topic in the conversation tool is supported by a visual, which was developed by a graphic design company in close collaboration with patients, proxies and HCPs. Results The conversation tool contains a total of 35 different topics covering six domains: physical health, daily life activities, psychological health, social relationships, loss of health and life, practical issues, all illustrated by a visual. The conversation tool can be given to the patient in booklet form before an appointment with the HCP, so they can prepare the conversation upfront. In addition, cards per domain will be available in the consultation room to be used during the appointment. Conclusion: By using the conversation tool, optimal individual guidance and support of patients with brain tumors is facilitated, as this patient population has unique issues that are often not covered by exiting tools. Using the conversation tool also promotes a nationally uniform way of working. Currently, an interactive tool for HCPs is being developed in which an overview of available interventions and best practices for the topics in the conversation tool are described, to ensure the needs of patients can be adequately addressed. The process of development of this tool can serve as an example for other cancer types.

Limitations of functional neuroimaging for patient selection and surgical planning in glioma surgery

The optimal surgical management of gliomas requires a balance between surgical cytoreduction and preservation of neurological function. Preoperative functional neuroimaging, such as functional MRI (fMRI) and diffusion tensor imaging (DTI), has emerged as a possible tool to inform patient selection and surgical planning. However, evidence that preoperative fMRI or DTI improves extent of resection, limits neurological morbidity, and broadens surgical indications in classically eloquent areas is lacking. In this review, the authors describe facets of functional neuroimaging techniques that may limit their impact on neurosurgical oncology and critically evaluate the evidence supporting fMRI and DTI for patient selection and operative planning in glioma surgery. The authors also propose alternative applications for functional neuroimaging in the care of glioma patients.

Patterns of Death and Palliative Care in Glioma Patients (P1.6-010)

Patterns of Death and Palliative Care in Glioma Patients (P1.6-010)

P01.089 The patients’ perspective on information level about supportive care in glioma patients - post-hoc evaluation and development of an online survey focusing on patients’ information needs, clinical studies and alternative therapies.

P01.089 The patients’ perspective on information level about supportive care in glioma patients - post-hoc evaluation and development of an online survey focusing on patients’ information needs, clinical studies and alternative therapies.

P01.010 Patterns of care in glioma patients surviving beyond ten years

P01.010 Patterns of care in glioma patients surviving beyond ten years

Transmural care for glioma patients and their family caregivers: utility and feasibility as perceived by professional caregivers

Transmural care for glioma patients and their family caregivers: utility and feasibility as perceived by professional caregivers

Attention dysfunction of postoperative patients with glioma

BackgroundAttention dysfunction has been observed among many kinds of nervous system diseases, including glioma. This study aimed to investigate the correlation between glioma localization, malignancy, postoperative recovery time and attention deficit.MethodsA total of 45 patients with glioma who underwent surgical resection and 18 healthy volunteers were enrolled. The attention network test, digital span test, color trail test II and Stroop test were used to detect the characteristics of attention deficit.ResultsOrientation network dysfunction was detected in the parietal lobe tumor group, and execution network deficit was detected in both the frontal and parietal lobe groups, while no significant difference was detected in the temporal lobe group compared to healthy controls. The high-grade glioma group (grade III-IV) exhibited more serious functional impairment than the low-grade group (grade I-II). No significant correlation was observed between postoperative recovery time and attention impairment.ConclusionsHigh-grade glioma patients suffer more severe attention impairment. In addition, the frontal and parietal lobe glioma patients suffer attention dysfunction in dissimilar manner. These findings will provide important guidance on the care of glioma patients after therapy.

Abstract 1266: Glioma biomarker discovery by mass spectrometry

Abstract BACKGROUND Approximately 200.000 people are diagnosed with a primary brain tumor each year worldwide. The most common type of primary brain tumor (∼40%) are gliomas. Currently available prognostic markers require evaluation of tumor tissue, such as 1p and 19q choromosome co-deletion in oligodendroglial tumors, MGMT promoter methylation for glioblastomas (GBMs), and IDH mutations in several glioma subtypes. Serum biomarkers that correlate with tumor status have prognostic and predictive value and could significantly improve the care for glioma patients. In addition biomarkers could provide unique information related to longitudinal response to therapy. The only clinically validated serum marker of prognosis and disease status in high grade gliomas is serum YKL-40, a chitinase homolog also called human cartilage glycoprotein 39 or chitinase 3-like 1. DESIGN/METHODS For the discovery phase we used a set of 31 cerebrospinal fluid samples. This sample set included 5 CSF samples of patients with a GBM and 26 controls. These samples were digested by trypsin and subsequently measured by LCMS-Orbitrap. The acquired data were analyzed using a database search and a subsequent analyses of the spectral counts by Scaffold. The spectral counts for each individual identified protein are used as a semi quantitative measure for protein abundance. RESULTS / CONCLUSIONS From the total list of 771 identified proteins, candidate biomarker proteins were selected that showed a significant difference between the control and GBM (p<0.01) and were at least 3 fold higher in spectral count than in the control group. Abundant serum proteins were removed to avoid inclusion of proteins that relate to the disruption of the blood-CSF barrier. Eventually, a list of eleven proteins was obtained that included 14-3-3 protein gamma, 72 kDa type IV collagenase, Alpha-enolase, Chitinase-3-like protein 1 (YKL-40), Fetuin-B, Glial fibrillary acidic protein, Insulin-like growth factor II, Metalloproteinase inhibitor 1, Serum paraoxonase/arylesterase 1, SPARC, IGF binding protein 2 and Metalloproteinase inhibitor 2. Many of the identified candidate markers have been previously reported in literature in relation to glioma including the clinically validated serum marker for glioma YKL-40. We are now planning a validation of these markers in a set of serum samples of glioma patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1266. doi:1538-7445.AM2012-1266

Abstract 4321: A critical role for IGFBP2 in the progression and maintenance of glioma

Abstract Despite recent advances in detection methods and treatments for other tumor types, the standard of care for glioma patients remains relatively unchanged and survival rates remain dismal. Identification of key signaling nodes that function throughout glioma development will likely provide new targets for intervention. To elucidate the role of the critical oncogene, IGFBP2, in the progression and maintenance of glioma, we generated an inducible mouse model. This model utilizes the RCAS/Tv-a system, which places the Tv-a receptor for the avian RCAS virus under the control of the Nestin promoter to drive Tv-a expression in glial progenitors. The RCAS virus, expressing the desired oncogenes, infects Tv-a expressing cells and delivers the oncogene. By using RCAS to express a tetracycline-responsive IGFBP2 and a tetracycline transactivator, we can modify this system to generate an inducible IGFBP2 model. Using this model, we have tested the hypothesis that IGFBP2 is a key target for glioma therapy due to its important role in glioma maintenance. The studies described here aim to: (1) determine the effects of delayed IGFBP2 expression on the progression of PDGFB-induced, low-grade gliomas; and (2) determine whether continued expression of IGFBP2 is required to maintain the high-grade nature of gliomas induced by the co-expression of PDGFB and IGFBP2. Previously, our lab and others determined that over-expression of PDGFB in glial progenitors led to the development of low-grade glioma. Our lab also determined that IGFBP2 cooperates with PDGFB to promote progression to high-grade glioma. In the inducible model system, tetracycline-mediated IGFBP2 induction in vivo was confirmed by both quantitative RT-PCR of mouse brain tissue and serum ELISA, indicating that RCAS-delivered IGFBP2 is both expressed and secreted upon induction. IGFBP2 induction from birth increased the proportion of tumors that progressed to high-grade glioma, whereas delayed IGFBP2 induction led to later onset of high-grade tumor development. Significantly, there was a decrease in tumor-free survival upon IGFBP2 induction. This is consistent with analysis of transcriptome data from the Rembrandt and TCGA databases. These studies validate an important role for IGFBP2 in the progression of glioma. Ongoing studies using the inducible system are exploring the response of high-grade gliomas to sustained and brief inactivation of IGFBP2. Elucidating the roles of IGFPB2 in glioma progression and maintenance will provide critical information pertinent to the design and implementation of future therapies to target this molecule or associated signaling pathways, as well as how IGFBP2 might be useful as a marker for disease state. Further, these studies may have a more global impact on cancer research as IGFBP2 over-expression has also been associated with other high-grade tumors such as prostate and breast cancers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4321. doi:10.1158/1538-7445.AM2011-4321