Al's Comment:
Returning to work after multimodal treatment in glioblastoma patients. This is one of the most important outcome of brain tumor treatments. It should be considered an important primary endpoint for clinical trials: what % of patients are able to work full time at the level of their previous job at 1,2,3 year point? What % of patients can work at least part time at any job at 1,2,3 years. This is important because for the first time, we are seeing long term survivors of GBMs who can actually work full time at high level jobs, many years down the line. Even if a treatment only improves median survival by a small amount, but allows those who do survive to engage in meaningful work - that is a breakthrough. For example, many years ago there were reports of a high % of long term survivors with intense radiation. However, it caused so much damage that most survivors were bedridden for the rest of their lives. More recently, with DC-Vax, ICT-107, Toca 511 / Toca FC, and others, we see some long term survivors who are functioning at the highest level - executive jobs, having families, driving and enjoying life. That is what we strive for. So it should be a formal endpoint!
Posted on: 06/02/2018
Neurosurg Focus. 2018 Jun;44(6):E17. doi: 10.3171/2018.3.FOCUS1819.
Returning to work after multimodal treatment in glioblastoma patients.
Starnoni D1, Berthiller J2, Idriceanu TM1, Meyronet D3,4, d'Hombres A5, Ducray F6,7, Guyotat J1.
Author information:
1. Neurosurgical Department, Oncological and Vascular Service, Pierre Wertheimer University Hospital, Lyon.
2. Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon.
3. Université Claude Bernard Lyon 1, Lyon.
4. Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuropathologie, Lyon; and.
5. Département de Radiothérapie, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France.
6. Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuro-Oncologie, Lyon.
7. Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon.
Abstract
OBJECTIVE Although multimodal treatment for glioblastoma (GBM) has resulted in longer survival, uncertainties exist regarding health-related quality of life and functional performance. Employment represents a useful functional end point and an indicator of social reintegration. The authors evaluated the rate of patients resuming their employment and the factors related to work capacity.
METHODS The authors performed a retrospective study of working-age patients treated with surgery and radiochemotherapy between 2012 and 2015. Data were collected before and after surgery and at 6, 12, 18, and 24 months. Employment was categorized according to the French Socio-Professional Groups and analyzed regarding demographic and clinical data, performance status, socio-professional category, radiological features, type, and quality of resection.
RESULTS A total of 125 patients, mean age 48.2 years, were identified. The mean follow-up was 20.7 months with a median survival of 22.9 months. Overall, 21 patients (18.3%) went back to work, most on a part-time basis (61.9%). Of the patients who were alive at 6, 12, 18, and 24 months after diagnosis, 8.7%, 13.8%, 15.3%, and 28.2%, respectively, were working. Patients going back to work were younger (p = 0.03), had fewer comorbidities (p = 0.02), and had a different distribution of socio-professional groups, with more patients belonging to higher occupation categories (p = 0.02). Treatment-related symptoms (36.2%) represented one of the main factors that prevented the resumption of work. Employment was strongly associated with performance status (p = 0.002) as well as gross-total removal (p = 0.04). No statistically significant difference was found regarding radiological or molecular features and the occurrence of complications after surgery.
CONCLUSIONS GBM diagnosis and treatment has a significant socio-professional impact with only a minority of patients resuming work, mostly on a part-time basis.
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