Impact quality of life and cognition functions in therapeutic decision in recurrence glioblastoma population

Résumé 0

Glioblastoma (GBM) is an aggressive and incurable disease that also affects patients’ independence and quality of life (QoL). Palliative care (PC) is applicable early in the course of the disease, in conjunction with other therapies designed to achieve the best possible life expectancy. In recurrent GBM, the decision to continue or discontinue specific therapies can be complex, and assessment of patients’ autonomy, cognitive function and QoL could help the physician in the therapeutic decision. In this work, we evaluated the influence of autonomy, cognitive function, and QoL on therapeutic choices (active or palliative treatment) in a real-world GBM population. Method: This is a prospective bi-centric study carried out between May 2021 and March 2022, of a population of patients with GBM in recurrence after radio-chemotherapy (RC). Two groups (active treatment or exclusive palliative care (EPC)) were defined according to the therapeutic decision at recurrence. Validated questionnaires were used for the assessment of independence in daily living (Karnofsky (KPS), Barthel index and IADL), cognitive function (MoCA) and QOL (EORTC QLQ-C30 and QLQ-BN20) to compare these two groups. Results: 94 patients were included (67 patients in the active management group, 27 patients in the EPC group). KPS, Barthel index and MoCA scores were lower in the EPC group (p < 0.001). There was a significant difference between the two groups in terms of QoL scores (global health status QoL p = 0.005). Multivariate analysis showed that only the “presence of home help” was associated with the medical decision (p = 0.01). Conclusion: Our study shows the association between the therapeutic decision and the patients’ autonomy, cognitive function and QoL scores. This study argues for the early and progressive integration of PC in the management of our patients with the use of QoL data and patient reported outcomes in clinical practice to facilitate integrative and personalized medicine, optimize supportive care and provide assistance in terms of therapeutic decision.