title: Postoperative deterioration in health related quality of life as predictor for survival in patients with glioblastoma: a prospective study.
abstract: BACKGROUND
  Studies indicate that acquired deficits negatively affect patients' self-reported health related quality of life (HRQOL) and survival, but the impact of HRQOL deterioration after surgery on survival has not been explored.
  
  
  OBJECTIVE
  Assess if change in HRQOL after surgery is a predictor for survival in patients with glioblastoma.
  
  
  METHODS
  Sixty-one patients with glioblastoma were included. The majority of patients (n = 56, 91.8%) were operated using a neuronavigation system which utilizes 3D preoperative MRI and updated intraoperative 3D ultrasound volumes to guide resection. HRQOL was assessed using EuroQol 5D (EQ-5D), a generic instrument. HRQOL data were collected 1-3 days preoperatively and after 6 weeks. The mean change in EQ-5D index was -0.05 (95% CI -0.15-0.05) 6 weeks after surgery (p = 0.285). There were 30 patients (49.2%) reporting deterioration 6 weeks after surgery. In a Cox multivariate survival analysis we evaluated deterioration in HRQOL after surgery together with established risk factors (age, preoperative condition, radiotherapy, temozolomide and extent of resection).
  
  
  RESULTS
  There were significant independent associations between survival and use of temozolomide (HR 0.30, p = 0.019), radiotherapy (HR 0.26, p = 0.030), and deterioration in HRQOL after surgery (HR 2.02, p = 0.045). Inclusion of surgically acquired deficits in the model did not alter the conclusion.
  
  
  CONCLUSIONS
  Early deterioration in HRQOL after surgery is independently and markedly associated with impaired survival in patients with glioblastoma. Deterioration in patient reported HRQOL after surgery is a meaningful outcome in surgical neuro-oncology, as the measure reflects both the burden of symptoms and treatment hazards and is linked to overall survival.
authors.affiliation: Department of Neurosurgery, St Olavs University Hospital, Trondheim, Norway. asgeir.s.jakola@ntnu.no
authors.forename: Asgeir S
authors.initials: AS
authors.lastname: Jakola
authors.forename: Sasha
authors.initials: S
authors.lastname: Gulati
authors.forename: Clemens
authors.initials: C
authors.lastname: Weber
authors.forename: Geirmund
authors.initials: G
authors.lastname: Unsgård
authors.forename: Ole
authors.initials: O
authors.lastname: Solheim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005909:Glioblastoma / Q000601:surgery*; D006262:Health; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome