Long-term quality of life in patients with vestibular schwannoma: An international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Matthew L. Carlson, Oystein Vesterli Tveiten, Colin L. Driscoll, Frederik K. Goplen, Brian A. Neff, Bruce E. Pollock, Nicole M. Tombers, Marina L. Castner, Monica K. Finnkirk, Erling Myrseth, Paal Henning Pedersen, Morten Lund-Johansen, Michael J. Link

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

OBJECT: The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument. METHODS:All patients with sporadic small-to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison. RESULTS:A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures. CONCLUSIONS:The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not confer a long-term HRQOL advantage, small- and medium-sized VS should be initially observed, while intervention should be reserved for patients with unequivocal tumor growth or intractable symptoms that are amenable to treatment. Future studies assessing HRQOL in VS patients should prioritize use of validated disease-specific measures, such as the PANQOL, given the significant limitations of generic instruments in distinguishing between treatment groups and tumor versus nontumor subjects.

Original languageEnglish (US)
Pages (from-to)833-842
Number of pages10
JournalJournal of Neurosurgery
Volume122
Issue number4
DOIs
StatePublished - Apr 1 2015

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Acoustic Neuroma
Microsurgery
Radiosurgery
Cross-Sectional Studies
Quality of Life
Observation
Therapeutics
Hearing
Neoplasms
Control Groups
Facial Pain
Health Surveys
Information Systems
Individuality
Publications
Mental Health
Anxiety

Keywords

  • Acoustic Neuroma
  • Cerebellopontine angle
  • Gamma knife radiosurgery
  • Microsurgery
  • Quality of life
  • Stereotactic radiosurgery
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Long-term quality of life in patients with vestibular schwannoma : An international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. / Carlson, Matthew L.; Tveiten, Oystein Vesterli; Driscoll, Colin L.; Goplen, Frederik K.; Neff, Brian A.; Pollock, Bruce E.; Tombers, Nicole M.; Castner, Marina L.; Finnkirk, Monica K.; Myrseth, Erling; Pedersen, Paal Henning; Lund-Johansen, Morten; Link, Michael J.

In: Journal of Neurosurgery, Vol. 122, No. 4, 01.04.2015, p. 833-842.

Research output: Contribution to journalArticle

Carlson, ML, Tveiten, OV, Driscoll, CL, Goplen, FK, Neff, BA, Pollock, BE, Tombers, NM, Castner, ML, Finnkirk, MK, Myrseth, E, Pedersen, PH, Lund-Johansen, M & Link, MJ 2015, 'Long-term quality of life in patients with vestibular schwannoma: An international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls', Journal of Neurosurgery, vol. 122, no. 4, pp. 833-842. https://doi.org/10.3171/2014.11.JNS14594
Carlson, Matthew L. ; Tveiten, Oystein Vesterli ; Driscoll, Colin L. ; Goplen, Frederik K. ; Neff, Brian A. ; Pollock, Bruce E. ; Tombers, Nicole M. ; Castner, Marina L. ; Finnkirk, Monica K. ; Myrseth, Erling ; Pedersen, Paal Henning ; Lund-Johansen, Morten ; Link, Michael J. / Long-term quality of life in patients with vestibular schwannoma : An international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. In: Journal of Neurosurgery. 2015 ; Vol. 122, No. 4. pp. 833-842.
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abstract = "OBJECT: The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument. METHODS:All patients with sporadic small-to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison. RESULTS:A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79{\%}, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures. CONCLUSIONS:The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not confer a long-term HRQOL advantage, small- and medium-sized VS should be initially observed, while intervention should be reserved for patients with unequivocal tumor growth or intractable symptoms that are amenable to treatment. Future studies assessing HRQOL in VS patients should prioritize use of validated disease-specific measures, such as the PANQOL, given the significant limitations of generic instruments in distinguishing between treatment groups and tumor versus nontumor subjects.",
keywords = "Acoustic Neuroma, Cerebellopontine angle, Gamma knife radiosurgery, Microsurgery, Quality of life, Stereotactic radiosurgery, Vestibular schwannoma",
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TY - JOUR

T1 - Long-term quality of life in patients with vestibular schwannoma

T2 - An international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

AU - Carlson, Matthew L.

AU - Tveiten, Oystein Vesterli

AU - Driscoll, Colin L.

AU - Goplen, Frederik K.

AU - Neff, Brian A.

AU - Pollock, Bruce E.

AU - Tombers, Nicole M.

AU - Castner, Marina L.

AU - Finnkirk, Monica K.

AU - Myrseth, Erling

AU - Pedersen, Paal Henning

AU - Lund-Johansen, Morten

AU - Link, Michael J.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - OBJECT: The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument. METHODS:All patients with sporadic small-to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison. RESULTS:A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures. CONCLUSIONS:The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not confer a long-term HRQOL advantage, small- and medium-sized VS should be initially observed, while intervention should be reserved for patients with unequivocal tumor growth or intractable symptoms that are amenable to treatment. Future studies assessing HRQOL in VS patients should prioritize use of validated disease-specific measures, such as the PANQOL, given the significant limitations of generic instruments in distinguishing between treatment groups and tumor versus nontumor subjects.

AB - OBJECT: The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument. METHODS:All patients with sporadic small-to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison. RESULTS:A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures. CONCLUSIONS:The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not confer a long-term HRQOL advantage, small- and medium-sized VS should be initially observed, while intervention should be reserved for patients with unequivocal tumor growth or intractable symptoms that are amenable to treatment. Future studies assessing HRQOL in VS patients should prioritize use of validated disease-specific measures, such as the PANQOL, given the significant limitations of generic instruments in distinguishing between treatment groups and tumor versus nontumor subjects.

KW - Acoustic Neuroma

KW - Cerebellopontine angle

KW - Gamma knife radiosurgery

KW - Microsurgery

KW - Quality of life

KW - Stereotactic radiosurgery

KW - Vestibular schwannoma

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