title: Determinants of quality of life in patients with skull base chordoma.
abstract: OBJECTIVE
  Skull base chordomas can be managed by surgical intervention and adjuvant radiotherapy. As survival for this disease increases, identification of determinants of quality of life becomes an important focus for guiding comprehensive patient care. In this study the authors sought to measure functional outcome and quality of life in patients with skull base chordomas and to identify determinants of quality of life in these patients.
  
  
  METHODS
  The authors carried out an internet-based cross-sectional survey, collecting detailed data for 83 individual patients. Demographic and clinical variables were evaluated. Functional outcomes were determined by Karnofsky Performance Scale (KPS) and Glasgow Outcome Scale Extended (GOSE), quality of life was measured using the 36-Item Short Form Health Survey (SF-36), and depression was assessed using Patient Health Questions-9 (PHQ-9) instrument. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Univariate and multivariate analysis was performed to identify determinants of the physical and mental components of the SF-36.
  
  
  RESULTS
  Patients with skull base chordomas who have undergone surgery and/or radiation treatment had a median KPS score of 90 (range 10-100, IQR 10) and a median GOSE score of 8 (range 2-8, IQR 3). The mean SF-36 Physical Component Summary score (± SD) was 43.6 ± 11.8, the mean Mental Component Summary score was 44.2 ± 12.6, and both were significantly lower than norms for the general US population (p < 0.001). The median PHQ-9 score was 5 (range 0-27, IQR 8). A PHQ-9 score of 10 or greater, indicating moderate to severe depression, was observed in 29% of patients. The median ZBI score was 12 (range 0-27, IQR 11), indicating a low burden. Neurological deficit, use of pain medication, and requirement for corticosteroids were found to be associated with worse SF-36 Physical Component Summary score, while higher levels of depression (higher PHQ-9 score) correlated with worse SF-36 Mental Component Summary score.
  
  
  CONCLUSIONS
  Patients with skull base chordomas have a lower quality of life than the general US population. The most significant determinants of quality of life in the posttreatment phase in this patient population were neurological deficits (sensory deficit and bowel/bladder dysfunction), pain medication use, corticosteroid use, and levels of depression as scored by PHQ-9.
authors.affiliation: Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto; and.
authors.forename: Roberto Jose
authors.initials: RJ
authors.lastname: Diaz
authors.forename: Nicole
authors.initials: N
authors.lastname: Maggacis
authors.forename: Shudong
authors.initials: S
authors.lastname: Zhang
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D017028:Caregivers; D002817:Chordoma / Q000150:complications / Q000523:psychology* / Q000532:radiotherapy; D015897:Comorbidity; D017281:Cost of Illness; D003627:Data Interpretation, Statistical; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D023261:Glasgow Outcome Scale; D006306:Health Surveys; D006801:Humans; D017567:Karnofsky Performance Status; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010361:Patients; D011788:Quality of Life; D011829:Radiation Dosage; D019292:Skull Base Neoplasms / Q000150:complications / Q000523:psychology* / Q000532:radiotherapy; D012907:Smoking / Q000523:psychology; D012959:Socioeconomic Factors; D055815:Young Adult