Abstracts

Rationale: Seizures represent significant co-morbidity in patients with high-grade gliomas (HGG). Approximately one-third of all brain tumor patients develop seizures and for some of them it is often the presenting symptom leading to diagnosis. Tumor-related epilepsy (TRE) is one of several potential factors that can detrimentally affect health-related quality of life (HRQOL) in patients with HGG. Rahman et al. found seizure burden to be an independent risk factors for poor HRQOL in a population of patients with mixed brain tumor types.1 In this study, the Functional Assessment of Cancer Therapy: brain subscale (FACT-Br) was used to assess HRQOL. The FACT-Br is a validated, disease-specific, instrument in assessing QOL in patients with brain tumor and includes questions about physical well-being, functional well-being, emotional well-being and additional concerns specific to patients with brain tumor.2 In addition to seizures, patients with HGG are subject to the effects of chemoradiation, among other pharmacological therapies which may impact HRQOL. The performance of the FACT-Br in association with TRE in a homogeneous population of patients with HGG has not been studied. We aim to study whether the presence or severity of seizures at tumor diagnosis significantly impacts HRQOL as measured by the FACT-Br and whether a subset of epilepsy-specific item responses on the FACT-Br might be more sensitive to clinically relevant seizure outcomes.  Methods: Adult patients with newly diagnosed high-grade gliomas were recruited into IRB-approved prospective study. The FACT-Br was given in paper form at baseline and repeated at 3 months, 6 months and 1 year. In addition to standard total and subscale FACT-Br testing, an “Epilepsy” well-being subscale was derived by reviewing the content of each survey item and comparing for similar content as seen in the validated, epilepsy-specific Quality of Life in Epilepsy 31 (QOLIE-31).4 Pertinent medical history was extracted from subject medical records including: seizure at diagnosis, level of seizure control, types of seizures, type and number of antiepileptic medications used, and tumor therapy.  Mean total and subscale baseline FACT-Br scores were compared between subject subgroups based on seizure status, active treatment with chemotherapy, radiation therapy, use of antiepileptic seizure drugs (AEDs), using t-tests or one-way ANOVA testing, as appropriate. Results: From 70 recruited subjects, 42 had evaluable baseline FACT-Br data. 17/42 subjects experienced a seizure prior to baseline assessment. The mean total FACT-Br score for subjects actively receiving chemotherapy was lower than those not actively receiving chemotherapy (141.1.0 vs 162.7, p= 0.03). There was no significant difference in mean baseline FACT-Br total or subscale score when comparing across groups based on active radiation therapy or treatment with AEDs. Mean total FACT-Br score in subjects with TRE was lower than those without, but this difference was not statistically significant (p=0.17). The mean Epilepsy well-being subscale score was lower in subjects with TRE (M=48.3, SD=13.1) than subjects without TRE (M=53.9, SD=11.1), but this difference was not statistically significant (p=0.14).  Conclusions: In this small sample, the baseline FACT-Br total and subscales did not detect a significant difference in patient-reported quality of life based on seizure-status. Active treatment with chemotherapy was associated with a significantly lower patient-reported quality of life. Further evaluation of the performance of the FACT-Br as a measure of HRQOL based on seizure status may benefit from a larger sample size with serial assessments over time.  Funding: No funding