1Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
2Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; and.
J Neurosurg. 2024 May 10;141(5):1270-1280. doi: 10.3171/2024.2.JNS221799. Print 2024 Nov 1.
As treatment for glioma advances, with an attendant improvement in length of patient survival, the quality of that survival has rightly become an increasingly important patient-centered metric, and health-related quality of life (HRQOL) an important outcome measure. HRQOL is a self-assessed, multidimensional concept encompassing the physical, emotional, and social components of quality of life associated with illness and its treatment. Neurosurgeons caring for patients with gliomas should be aware of the latest research on HRQOL to understand mechanisms by which it can be improved. Neurosurgical outcomes related to surgical complications and neurological deficits can be important determinants of HRQOL and are well understood by neurosurgeons. However, an understanding of more general or global determinants of HRQOL not commonly addressed in the clinic, and implementation of the attendant evidence-based interventions to address them, would be transformative. The authors explore HRQOL determinants related to patient-, social-, tumor-, and treatment-related factors, with a particular emphasis on the strongest determinants, fatigue, sleep disturbance, anxiety, depression, neurocognitive dysfunction, caregiver distress, and end-of-life concerns. Evidence-based interventions are reviewed, including fatigue management, cognitive rehabilitation, insomnia interventions exercise, caregiver training, palliative care, and an overall multidisciplinary team approach. Lastly, features of a program are outlined that would embed HRQOL in neurosurgical care to the benefit of both patients and staff.
随着胶质瘤治疗的进展，患者的生存时间得以延长，生存质量理所当然地成为了一个越来越重要的以患者为中心的衡量标准，健康相关生活质量（HRQOL）成为了一个重要的结果衡量指标。HRQOL 是一个自我评估的多维概念，涵盖了与疾病及其治疗相关的生活质量的身体、情感和社会方面。照顾胶质瘤患者的神经外科医生应该了解最新的 HRQOL 研究，以了解可以改善 HRQOL 的机制。与手术并发症和神经功能缺损相关的神经外科结果可以是 HRQOL 的重要决定因素，这是神经外科医生所熟知的。然而，了解通常在临床中未涉及的更一般或更全局的 HRQOL 决定因素，并实施相应的基于证据的干预措施来解决这些问题，将具有变革性。作者探讨了与患者、社会、肿瘤和治疗相关因素相关的 HRQOL 决定因素，特别强调了最强的决定因素，即疲劳、睡眠障碍、焦虑、抑郁、神经认知功能障碍、照顾者的痛苦和临终关怀问题。作者回顾了基于证据的干预措施，包括疲劳管理、认知康复、失眠干预、锻炼、照顾者培训、姑息治疗以及整体多学科团队方法。最后，概述了一个将 HRQOL 纳入神经外科护理的计划的特点，这将使患者和工作人员受益。
