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Personalised support of brain tumour patients during radiotherapy based on psychological profile and quality of life

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Abstract

Purpose

Psychological distress in primary malignant brain tumour (PMBT) patients is associated with poorer outcomes. Radiotherapy (RT) often induces side effects that significantly influence patients’ quality of life (QoL), with potential impact on survival. We evaluated distress, anxiety, depression, and QoL over time to identify patients with difficulties in these areas who required more intense psychological support.

Methods

Psychological questionnaires—Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy (FACT-G and FACT-Br)—were completed at the beginning (T0), in the middle (T1), directly after RT (T2), and 3 months after RT (T3). We personalised the psychological support provided for each patient with a minimum of three sessions (‘typical’ schedule) and a maximum of eight sessions (‘intensive’ schedule), depending on the patients’ psychological profiles, clinical evaluations, and requests. Patients’ survival was evaluated in the glioblastoma multiforme (GBM) patients, with an explorative intent.

Results

Fifty-nine consecutive PMBT patients receiving post-operative RT were included. For patients who were reported as ‘not distressed’ at T0, no statistically significant changes were noted. In contrast, patients who were ‘distressed’ at T0 showed statistically significant improvements in DT, HADS, FACT-G, and FACT-Br scores over time. ‘Not distressed’ patients required less psychological sessions over the study duration than ‘distressed’ patients. Interestingly, ‘not distressed’ GBM patients survived longer than ‘distressed’ GBM patients.

Conclusions

Increased psychological support improved distress, mood, and QoL for patients identified as ‘distressed’, whereas psychological well-being was maintained with typical psychological support in patients who were identified as being ‘not distressed’. These results encourage a standardisation of psychological support for all RT patients.

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Data availability

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References

  1. Kangas M (2015) Psychotherapy interventions for managing anxiety and depressive symptoms in adult brain tumour patients: a scoping review. Front Oncol 5:116

    Article  Google Scholar 

  2. Jiao JT, Sun J, Ma JF, Dai MC, Huang J, Jiang C, Wang C, Cheng C, Shao JF (2015) Relationship between inflammatory cytokines and risk of depression, and effect of depression on the prognosis of high grade glioma patients. J Neurooncol 124:475–484

    Article  CAS  Google Scholar 

  3. Keir ST, Calhoun-Eagan RD, Swartz JJ, Saleh OA, Friedman HS (2008) Screening for distress in patients with brain cancer using the NCCN’s rapid screening measure. Psycho-oncology 17:621–625

    Article  Google Scholar 

  4. Janda M, Steginga S, Dunn J, Langbecker D, Walker D, Eakin E (2008) Unmet supportive care needs and interest in services among patients with a brain tumour and their carers. Patient Educ Couns 71:251–258

    Article  Google Scholar 

  5. Madsen K, Poulsen HS (2011) Needs for everyday life support for brain tumor patients’ relatives: systematic literature review. Eur J Cancer Care (Engl) 20:33–43

    Article  CAS  Google Scholar 

  6. Aprile I, Chiesa S, Padua L, Di Blasi C, Arezzo MF, Valentini V, Di Stasio E, Balducci M (2015) Occurrence and predictors of the fatigue in high-grade glioma patients. Neurol Sci. 36:1363–1369

    Article  Google Scholar 

  7. Trad W, Koh ES, Daher M et al (2015) Screening for psychological distress in adult primary brain tumor patients and caregivers: considerations for cancer care coordination. Front Oncol 5:203

    Article  Google Scholar 

  8. Stupp R, Mason MP, Van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996

    Article  CAS  Google Scholar 

  9. Greene-Schloesser D, Robbins ME, Peiffer AM, Shaw EG, Wheeler KT, Chan MD (2012) Radiation-induced brain injury: a review. Front Oncol 19;2:73

  10. Kangas M, Tate RL, Williams JR, Smee (2012) The effects of radiotherapy on psychosocial and cognitive functioning in adults with a primary brain tumor: a prospective evaluation. Neuro Oncol 14:1485–1502

    Article  Google Scholar 

  11. Randazzo DM, McSherry F, Herndon JE et al (2017) A cross sectional analysis from a single institution’s experience of psychosocial distress and health-related quality of life in the primary brain tumor population. J Neurooncol 134:363–369

    Article  Google Scholar 

  12. Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S (2017) Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours. Nat Rev Neurol 13:52–64

    Article  CAS  Google Scholar 

  13. Satin JR, Linden W, Phillips MJ (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 22:5349–5361

    Article  Google Scholar 

  14. Litofsky NS, Resnick AG (2009) The relationships between depression and brain tumors. J Neurooncol 94:153–161

    Article  Google Scholar 

  15. Noll KR, Sullaway CM, Wefel JS (2019) Depressive symptoms and executive function in relation to survival in patients with glioblastoma. J Neurooncol 142:183–191

    Article  Google Scholar 

  16. Shi C, Lamba NL, Zheng J et al (2018) Depression and survival of glioma patients: a systematic review and meta-Analysis. Clin Neurol Neurosurg 172:8–19

    Article  CAS  Google Scholar 

  17. Bunevicius A (2018) Personality traits, patient-centered health status and prognosis of brain tumor patients. J Neurooncol 137:593–600

    Article  Google Scholar 

  18. Kangas M, McDonald S, Williams JR, Smee RI (2015) Acceptance and commitment therapy program for distressed adults with a primary brain tumor: a case series study. Support Care Cancer 23:2855–2859

    Article  Google Scholar 

  19. Szpringer M, Oledzka M, Amann BL (2018) A non-randomized controlled trial of EMDR on affective symptoms in patients with Glioblastoma Multiforme. Front Psychol 9:785

    Article  Google Scholar 

  20. Pan-Weisz TM, Kryza-Lacombe M, Burkeen J, Hattangadi-Gluth J, Malcarne VL, McDonald CR (2019) Patient-reported health-related quality of life outcomes in supportive-care interventions for adults with brain tumors: a systematic review. Psychooncology 28:11–21

    Article  Google Scholar 

  21. Bitterlich C, Vordermark D (2017) Analysis of health-related quality of life in patients with brain tumors prior and subsequent to radiotherapy. Oncol Lett 14:1841–1846

    Article  Google Scholar 

  22. Cordier D, Gerber M, Brand S (2019) Effects of two types of exercise training on psychological well-being, sleep, quality of life and physical fitness in patients with high-grade glioma (WHO III and IV): Study protocol for a randomized controlled trial cancer. Commun (Lond) 39(1):46

    Google Scholar 

  23. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  Google Scholar 

  24. Ferrucci L, Cecchi F, Guralnik JM, Giampaoli S, Lo Noce C, Salani B, Bandinelli S, Baroni A (1996) Does the Clock Drawing Test predict cognitive decline in older persons independent of the Mini-Mental State Examination? The FINE Study Group. Finland, Italy, The Netherlands Elderly. J Am Geriatr Soc 44:1326–1331

    Article  CAS  Google Scholar 

  25. Appollonio I, Leone M, Isella V, Piamarta F, Consoli T, Villa ML, Forapani E, Russo A, Nichelli P (2005) The Frontal Assessment Battery (FAB): Normative values in an Italian population sample. Neurol Sci 26:108–116

    Article  CAS  Google Scholar 

  26. NCCN clinical practice guidelines in oncology 2018_central nervous system cancer. Version 2.2018_November 26, 2018

  27. Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, DeGroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM (2010) Updated response assessment criteria for high grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972

    Article  Google Scholar 

  28. Perls F, Hefferline R, Goodman P (1951) Gestalt therapy, excitement and growth in the human personality. Dell Publications, New York

    Google Scholar 

  29. Zinker JC (1977) Creative process in Gestalt psychotherapy. Vintage Books

  30. Grassi L, Johansen C, Annunziata MA, Capovilla E, Costantini A, Gritti P, Torta R, Bellani M, Italian Society of Psycho-Oncology Distress Thermometer Study Group (2013) Screening for distress in cancer patients: a multicenter, nationwide study in Italy. Cancer 119:1714–1721

    Article  Google Scholar 

  31. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  Google Scholar 

  32. Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, Robertson B, Bliss J (1991) The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Br J Psychiat 158:255–259

    Article  CAS  Google Scholar 

  33. Ibbotson T, Maguire P, Selby P, Priestman T, Wallace L (1994) Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 30:37–40

    Article  Google Scholar 

  34. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579

    Article  CAS  Google Scholar 

  35. Weitzner MA, Meyers CA, Gelke CK, Byrne KS, Cella DF, Levin VA (1995) The Functional Assessment of Cancer Therapy (FACT) scale. Development of a brain subscale and revalidation of the general version (FACT-G) in patients with primary brain tumors. Cancer. 75:1151–1161

    Article  CAS  Google Scholar 

  36. Gorlia T, van den Bent MJ, Hegi ME et al (2008) Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol 9:29–38

    Article  Google Scholar 

  37. Gittleman H, Ostrom QT, Stetson LC et al (2019) Sex is an important prognostic factor for glioblastoma but not for nonglioblastoma. Neuro-Oncol Pract. 6:451–462

    Article  Google Scholar 

  38. Jiang C, Wang J (2019) Post-traumatic stress disorders in patients with low-grade glioma and its association with survival. J Neurooncol 142:385–392

  39. Allen JO, Zebrack B, Wittman D, Hammelef K, Morris AM (2014) Expanding the NCCN guidelines for distress management: a model of barriers to the use of coping resources. J Community Support Oncol 12:271–227

    Article  Google Scholar 

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Acknowledgements

We would like to thank Franziska M. Lohmeyer for her support revising and editing our manuscript.

Author information

Authors and Affiliations

  1. UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Loredana Dinapoli, Silvia Chiesa, Nicola Dinapoli, Francesco Beghella Bartoli, Serena Bracci, Ciro Mazzarella, Vincenzo Frascino, Vincenzo Valentini & Mario Balducci

  2. Unità Operativa Semplice di Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Loredana Dinapoli

  3. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy

    Roberto Gatta, Maria Zoe Sanfilippo, Vincenzo Valentini & Mario Balducci

  4. Dipartimento di Neurochirurgia, Ospedale Mater Olbia, Olbia, Italy

    Giovanni Sabatino

  5. Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy

    Giovanni Sabatino

  6. UOC di Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Simona Gaudino

  7. UOC di Neurochirurgia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Giuseppe Maria Della Pepa

Authors
  1. Loredana Dinapoli
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  2. Silvia Chiesa
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  3. Nicola Dinapoli
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  4. Roberto Gatta
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  7. Ciro Mazzarella
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  8. Maria Zoe Sanfilippo
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  9. Giovanni Sabatino
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  10. Simona Gaudino
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  11. Giuseppe Maria Della Pepa
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  12. Vincenzo Frascino
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  13. Vincenzo Valentini
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  14. Mario Balducci
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Contributions

Loredana Dinapoli, Silvia Chiesa, Nicola Dinapoli, and Mario Balducci contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Loredana Dinapoli, Nicola Dinapoli, Roberto Gatta, Francesco Beghella Bartoli, Ciro Mazzarella Serena Bracci, and Maria Zoe Sanfilippo. The first draft of the manuscript was written by Loredana Dinapoli and all authors commented on previous versions of the manuscript.

Corresponding author

Correspondence to Silvia Chiesa.

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Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study

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Dinapoli, L., Chiesa, S., Dinapoli, N. et al. Personalised support of brain tumour patients during radiotherapy based on psychological profile and quality of life. Support Care Cancer 29, 4555–4563 (2021). https://doi.org/10.1007/s00520-021-06000-7

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  • DOI: https://doi.org/10.1007/s00520-021-06000-7

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