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Intracranial tumor preoperative patient-reported quality-of-life measures predict post-operative high-value care
Arnav Khera1, Mazin Elshareif1, Foad Kazemi1
1Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Background And Objectives:
There has been increasing interest in the application of patient-reported outcome measures (PROMs) in estimating the appropriateness of surgery for patients with glioblastomas and metastatic brain lesions. This study investigated the association between pre-operative patient-reported quality-of-life measurements and post-operative health-related outcomes in malignant intracranial tumor patients.
Methods:
A series of malignant intracranial tumor patients pre-operatively completed the PROMIS®-29 v2.0 survey. Multivariate logistic regressions analyzed associations between survey subscores and postoperative outcomes. Secondary analyses compared glioblastoma and metastatic lesion subpopulations. Finally, predictive ability of PROMIS-29 scores was compared to Karnofsky Performance Status (KPS), American Society of Anesthesiologists (ASA), and 5-factor modified Frailty Index (mFI-5).
Results:
This study included 58 patients (mean age 62.02 years; 46.6% female). Compared to the general US population, the overall cohort and metastatic lesion subpopulation had higher Anxiety/Fear (p < 0.001) and lower Physical Function (p < 0.001). Adjusting for demographics, Physical Function was associated with home discharge (AOR, 1.106; p = 0.010), 90-day readmission (AOR, 0.892; p = 0.004), 90-day mortality (AOR=0.861; p = 0.021), and overall survival (HR=0.935, p = 0.014, Cox regression). In the metastatic lesion subpopulation, Physical Function was associated with home discharge (OR=1.335; p = 0.023) while Anxiety/Fear was associated with 90-day mortality (OR=1.514; p = 0.044). Physical Function better predicted 90-day mortality (AUROC=0.832) than the ASA (0.538), KPS (0.501), or mFI-5 (0.487).
Conclusion:
Patient-reported outcome measures, especially physical function, can be predictive of discharge disposition, readmission, and mortality. Along with other pertinent QoL measures, these metrics may be helpful when weighing treatment options. Additional research is needed to evaluate associations between longitudinal changes in survey scores and outcomes.