Original ArticleHealth-Related Quality of Life and Posttraumatic Growth in Low-Grade Gliomas in China: A Prospective Study
Introduction
Low-grade gliomas (LGGs) arise from the glial matter in the brain, which include all World Health Organization grade I and II gliomas. Every year, approximately 15,000 individuals are diagnosed with LGGs in China.1, 2 In most cases, LGGs will recur and progress to high-grade gliomas. Moreover, approximately 80% of patients have seizures as well as other neurologic symptoms.3, 4 Thus, LGGs negatively affect the quality of life (QoL) of these patients. QoL is a multidimensional concept that covers not only physical well-being but also mental well-being. Cheng et al.5 investigated QoL in patients with glioma in China, and they found that gliomas had a dramatic impact on the patients' lives both physically and psychologically. The negative consequences of LGGs have been well documented.6, 7 However, few studies have focused on the positive psychological part of LGGs.
As we know, individuals who are exposed to traumatic life events also may perceive at least some positive changes, such as posttraumatic growth (PTG).8 PTG refers to the positive psychological change that can occur as a result of a struggle with highly challenging adverse life events.9, 10 To our knowledge, although PTG resulting from LGGs frequently is reported by survivors, few studies have examined the impact of perceived PTG on the QoL of patients with LGG. It is important to identify this relationship, as it may provide potential interventions for maintaining the QoL of patients with LGGs over time.
Previous studies have explored the relationship between QoL and PTG after cancer, but the results are contradictory.10, 11, 12 Some studies found a positive relationship between PTG and QoL,13 which makes sense. However, a few studies also suggested a null or negative relationship between them.11, 14 In addition, Tomich and Helgeson12 found a curvilinear relation between PTG and QoL in patients with cancer. Specifically, patients with high and low levels of PTG had better QoL than those with moderate levels, which suggested the relationship between PTG and QoL may be complex and dynamic. However, the sample size in their study was too small to acquire enough statistical power; it would be necessary to verify this finding by using a relatively large sample in a prospective study. Moreover, a previous study found that minorities were more likely to report greater levels of PTG than white participants15; therefore, it is intriguing to investigate the PTG level of Chinese patients.
Based on the aforementioned reasons, we conducted a prospective study with the following objectives: 1) to describe the PTG and QoL changes during the first year after surgery in a Chinese sample; 2) to identify determinants of QoL with an emphasis on the roles of perceived PTG; and 3) to examine the linear and quadratic relationship between QoL and PTG.
Section snippets
Power Analysis
Before we selected participants of the present study, a power analysis was conducted to make sure that enough statistical power and sample size could be achieved. Figure 1 presents the results of power analysis for the linear model. According to previous studies,12, 16 the effect sizes for PTG and many health outcomes ranged from null to medium; therefore, to acquire 90% statistical power under the conditions of small or medium effect size (e.g., 0.15 ∼ 0.20) and 0.05 confidence level, at least
Participant Demographics and Medical Characteristics
As shown in Table 1, there were 260 participants in the final data analysis. One hundred forty-five were male (55.80%) and 115 were female (44.20%), with a median age of 42 years (range, 18–67) and a median KPS score of 90. A total of 87 (33.50%) participants had uncontrolled seizures, and 173 (66.50%) did not. In terms of tumor location, 119 (45.80%) of tumors were located in the left hemisphere, and 137 (52.70%) were located in the right hemisphere. Four (1.50%) tumors involved bilateral
Discussion
The present prospective study investigated the changes of PTG and QoL in 2 measurement time points and examined potential determinants of QoL and the quadratic relationship between PTG and QoL. To our knowledge, this is the first study to examine the QoL results and relationship between the QOL and PTG in a large sample of patients with LGG. First, we identified time, PTG score, insurance, SES, and right hemisphere tumor position as positive predictors of QoL; seizure and depression negatively
Change of QoL and PTG
We found that the QoL experienced an increasing trend over time, which agrees with the previous study.20 Patients in our study already had finished their painful treatment and perceived PTG after surgery, so it is possible to observe the improvement of QoL. We found emotional well-being, functional well-being, and brain specific also had an obvious increasing trend, but social and physical well-being remained stable. The reason for improvements in emotional well-being may be related to the
Conclusions
In general, PTG and QoL increased over time; in particular, spiritual change and appreciation of life showed a dramatic increasing trend. Perceived PTG could significantly predict QoL of LGG survivors 1 year after the surgery. To maintain and improve the QoL of patients, interventions could be used to promote the perceived PTG.
Acknowledgments
The authors thank Professor Wenying Shi at Thomas Jefferson University Hospital for his professional assistance and the financial support from the China Scholarship Council.
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Conflict of interest statement: This research is supported by the Sichuan Provincial Science and Technology Department (Grant No. 2016FZ0119) and Central China Normal University (Grant No. 2017YBZZ083).
Xiaoyu Wang and Junyi Li contributed equally to the study and considered as co–first author.