title: Symptoms and socio-economic impact of ependymoma on adult patients: results of the Adult Ependymoma Outcomes Project 2.
abstract: Ependymoma is a rare central nervous system tumor of adults. Reports of patient symptoms, interference patterns and costs encountered by patients and families are limited. Adult ependymoma patients completed the online Ependymoma Outcomes Questionnaire II. The survey assesses disease and functional status as well as socio-economic factors. Descriptive statistics were used to report disease characteristics as well as economic and social impact. Independent samples t test was used to test if differences exist between high- and low-income groups in terms of symptom severity. Correlations were calculated between symptoms and cost estimates. 86 international patients participated (male = 50 %). The economic analysis focused on 78 respondents from the US. 48 % were employed and 55 % earned ≥$60,000. Tumors were located in the brain (44 %), spine (44 %) or both (12 %). Spine patients compared to brain patients reported significantly worse pain (4.4 versus 2.2, p < .003), numbness (5.3 versus 2.2, p < .001), fatigue (5.1 versus 3.6, p < .03), changes in bowel patterns (3.8 versus 1.4, p < .003) and weakness (4.2 versus 2.1, p < .006). Brain patients compared with spine patients had increased lack of appetite (.4 versus 2, p < .014). Patients with lower income (≤$59,999) had more problems concentrating (p < .024) and worse cognitive module severity scores (p < .024). Estimated average monthly out-of-pocket spending was $168 for medical co-pays and $59 for prescription medication. Patients with ependymoma are highly affected by their symptoms. Spinal patients report higher severity of symptoms. Patients in the lower income group report significantly higher severity of cognitive symptoms independent of disease site.
authors.affiliation: Department of Neurosurgery and Neurology, Henry Ford Health System Detroit, 2799 W Grand Blvd, Detroit, MI, 48202, USA, twalber1@hfhs.org.
authors.forename: Tobias
authors.initials: T
authors.lastname: Walbert
authors.forename: Tito R
authors.initials: TR
authors.lastname: Mendoza
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Vera-Bolaños
authors.forename: Alvina
authors.initials: A
authors.lastname: Acquaye
authors.forename: Mark R
authors.initials: MR
authors.lastname: Gilbert
authors.forename: Terri S
authors.initials: TS
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D000368:Aged; D016543:Central Nervous System Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D017281:Cost of Illness; D004806:Ependymoma / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult