Top

Journal of Neuro-Oncology

Published in:

01-08-2020 | Lymphoma | Clinical Study

Complete response to therapy: why do primary central nervous system lymphoma patients not return to work?

Authors: Greta Wiemann, Milena Pertz, Thomas Kowalski, Sabine Seidel, Uwe Schlegel, Patrizia Thoma

Published in: Journal of Neuro-Oncology | Issue 1/2020

Abstract

Purpose

Although primary central nervous system lymphomas (PCNSL) represent extremely aggressive brain tumours, high-dose methotrexate in combination with other chemotherapeutic agents has resulted in long-term disease control in a substantial fraction of patients. Advances in treatment efficacy with longer survival resulted in a focus on additional outcome measures such as quality of life (QoL) and neurocognition. Despite recent evidence of return to work as an important aspect of patients' QoL, little is known about occupational reintegration in PCNSL long-term survivors. This study aimed to detect specific characteristics of patients who successfully resumed work after complete response to therapy.

Methods

Patients with ongoing complete response to therapy completed a test battery capturing neurocognition, social integration, QoL and psychological burden. Of 25 patients who had been in regular employment before diagnosis only eight returned to work after treatment (32%).

Results

Patients who resumed work rated important aspects of their QoL and social integration as higher and suffered less from symptoms affecting QoL than patients who did not resume work. Also, the subjective confidence in their ability to work was higher in patients who resumed work, but independent predictors of return to work were not found in logistic regression analyses.

Conclusion

Occupational (re)integration is of clinical relevance in PCNSL patients after complete response to therapy. Due to the small size of our cohort the present results should be considered an exploratory first step. Return to work might be a crucial aspect of QoL and (re)integration into society after cure of PCNSL.

Available only for authorised users

Batchelor TT (2019) Primary central nervous system lymphoma: a curable disease. Hematol Oncol 37(Suppl 1):15–18. https://doi.org/10.1002/hon.2598CrossRefPubMed

Villano JL, Koshy M, Shaikh H et al (2011) Age, gender, and racial differences in incidence and survival in primary CNS lymphoma. Br J Cancer 105(9):1414–1418. https://doi.org/10.1038/bjc.2011.357CrossRefPubMedPubMedCentral

Seidel S, Schlegel U (2019) Have treatment protocols for primary CNS lymphoma advanced in the past 10 years. Expert Rev Anticancer Ther 19(10):909–915. https://doi.org/10.1080/14737140.2019.1677157CrossRefPubMed

Harder H, Holtel H, Bromberg JEC et al (2004) Cognitive status and quality of life after treatment for primary CNS lymphoma. Neurology 62(4):544–547. https://doi.org/10.1212/wnl.62.4.544CrossRefPubMed

Correa DD, Maron L, Harder H et al (2007) Cognitive functions in primary central nervous system lymphoma: literature review and assessment guidelines. Ann Oncol 18(7):1145–1151. https://doi.org/10.1093/annonc/mdl464CrossRefPubMed

Correa DD, Shi W, Abrey LE et al (2012) Cognitive functions in primary CNS lymphoma after single or combined modality regimens. Neuro-oncology 14(1):101–108. https://doi.org/10.1093/neuonc/nor186CrossRefPubMed

Thiel E, Korfel A, Martus P et al (2010) High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol 11(11):1036–1047. https://doi.org/10.1016/S1470-2045(10)70229-1CrossRefPubMed

Seidel S, Korfel A, Kowalski T et al (2019) HDMTX-based induction therapy followed by consolidation with conventional systemic chemotherapy and intraventricular therapy (modified Bonn protocol) in primary CNS lymphoma: a monocentric retrospective analysis. Neurol Res Pract 1(1):iv1. https://doi.org/10.1186/s42466-019-0024-2CrossRef

Hoffman MA, Lent RW, Raque-Bogdan TL (2013) A social cognitive perspective on coping with cancer. Couns Psychol 41(2):240–267. https://doi.org/10.1177/0011000012461378CrossRef

10.

Fliessbach K, Helmstaedter C, Urbach H et al (2005) Neuropsychological outcome after chemotherapy for primary CNS lymphoma: a prospective study. Neurology 64(7):1184–1188. https://doi.org/10.1212/01.WNL.0000156350.49336.E2CrossRefPubMed

11.

Juergens A, Pels H, Rogowski S et al (2010) Long-term survival with favorable cognitive outcome after chemotherapy in primary central nervous system lymphoma. Ann Neurol 67(2):182–189. https://doi.org/10.1002/ana.21824CrossRefPubMed

12.

Doolittle ND, Korfel A, Lubow MA et al (2013) Long-term cognitive function, neuroimaging, and quality of life in primary CNS lymphoma. Neurology 81(1):84–92. https://doi.org/10.1212/WNL.0b013e318297eeba CrossRefPubMedPubMedCentral

13.

Vargo M, Henriksson R, Salander P (2016) Rehabilitation of patients with glioma. Handb Clin Neurol 134:287–304. https://doi.org/10.1016/B978-0-12-802997-8.00017-7CrossRefPubMed

14.

Kaplan CP, Miner ME (1997) Anxiety and depression in elderly patients receiving treatment for cerebral tumours. Brain Inj 11(2):129–135CrossRef

15.

Ozbay F, Johnson DC, Dimoulas E et al (2007) Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry 4(5):35–40PubMed

16.

Gheaus A, Herzog L (2016) The goods of work (other than money!). J Soc Philos 47(1):70–89. https://doi.org/10.1111/josp.12140CrossRef

17.

Hanson A (2007) Workplace health promotion: a salutogenic approach. AuthorHouse, Bloomington

18.

Saunders SL, Nedelec B (2014) What work means to people with work disability: a scoping review. J Occup Rehabil 24(1):100–110. https://doi.org/10.1007/s10926-013-9436-yCrossRefPubMed

19.

Alaszewski A, Alaszewski H, Potter J et al (2007) Working after a stroke: survivors' experiences and perceptions of barriers to and facilitators of the return to paid employment. Disabil Rehabil 29(24):1858–1869. https://doi.org/10.1080/09638280601143356CrossRefPubMed

20.

Main DS, Nowels CT, Cavender TA et al (2005) A qualitative study of work and work return in cancer survivors. Psycho-Oncology 14(11):992–1004. https://doi.org/10.1002/pon.913CrossRefPubMed

21.

Karnofsky DA, Abelmann WH, Craver LF et al (1948) The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1(4):634–656CrossRef

22.

Péus D, Newcomb N, Hofer S (2013) Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation. BMC Med Inform Decis Mak 13:72. https://doi.org/10.1186/1472-6947-13-72CrossRefPubMedPubMedCentral

23.

Ebener M (ed) (2013) Why WAI?: Der Work Ability Index im Einsatz für Arbeitsfähigkeit und Prävention - Erfahrungsberichte aus der Praxis, 5. Aufl., Dezember 2013. Bundesanst. für Arbeitsschutz und Arbeitsmedizin (BAuA), Dortmund

24.

Callaway L, Winkler D, Tippett A et al (2016) The community integration questionnaire—revised: Australian normative data and measurement of electronic social networking. Aust Occup Ther J 63(3):143–153. https://doi.org/10.1111/1440-1630.12284CrossRefPubMed

25.

Willer B, Ottenbacher KJ, Coad ML (1994) The community integration questionnaire. A comparative examination. Am J Phys Med Rehabil 73(2):103–111. https://doi.org/10.1097/00002060-199404000-00006CrossRefPubMed

26.

Fliessbach K, Rogowski S, Hoppe C et al (2010) Computer-based assessment of cognitive functions in brain tumor patients. J Neurooncol 100(3):427–437. https://doi.org/10.1007/s11060-010-0194-9CrossRefPubMed

27.

Fliessbach K, Hoppe C, Schlegel U et al (2006) NeuroCogFX–eine computergestützte neuropsychologische Testbatterie für Verlaufsuntersuchungen bei neurologischen Erkrankungen (NeuroCogFX–a computer-based neuropsychological assessment battery for the follow-up examination of neurological patients). Fortschr Neurol Psychiatr 74(11):643–650. https://doi.org/10.1055/s-2006-932162CrossRefPubMed

28.

Flechl B, Ackerl M, Sax C et al (2012) Neurocognitive and sociodemographic functioning of glioblastoma long-term survivors. J Neurooncol 109(2):331–339. https://doi.org/10.1007/s11060-012-0897-1CrossRefPubMed

29.

Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376. https://doi.org/10.1093/jnci/85.5.365CrossRefPubMed

30.

Taphoorn MJB, Claassens L, Aaronson NK et al (2010) An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients. Eur J Cancer 46(6):1033–1040. https://doi.org/10.1016/j.ejca.2010.01.012CrossRefPubMed

31.

Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.xCrossRefPubMed

32.

Cocchiara RA, Sciarra I, D’Egidio V et al (2018) Returning to work after breast cancer: a systematic review of reviews. Work 61(3):463–476. https://doi.org/10.3233/WOR-182810CrossRefPubMed

33.

de Boer AGEM, Taskila T, Ojajärvi A et al (2009) Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA 301(7):753–762. https://doi.org/10.1001/jama.2009.187CrossRefPubMed

34.

Starnoni D, Berthiller J, Idriceanu T-M et al (2018) Returning to work after multimodal treatment in glioblastoma patients. Neurosurg Focus 44(6):E17. https://doi.org/10.3171/2018.3.FOCUS1819CrossRefPubMed

35.

Gzell C, Wheeler H, Guo L et al (2014) Employment following chemoradiotherapy in glioblastoma: a prospective case series. J Cancer Surviv 8(1):108–113. https://doi.org/10.1007/s11764-013-0311-9CrossRefPubMed

36.

Hodson DJ, Bowles KM, Cooke LJ et al (2005) Primary central nervous system lymphoma: a single-centre experience of 55 unselected cases. Clin Oncol 17(3):185–191. https://doi.org/10.1016/j.clon.2004.10.007CrossRef

37.

Kiewe P, Fischer L, Martus P et al (2008) Primary central nervous system lymphoma. Cancer 112(8):1812–1820. https://doi.org/10.1002/cncr.23377CrossRefPubMed

38.

Hoofien D, Gilboa A, Vakil E et al (2001) Traumatic brain injury (TBI) 10–20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Inj 15(3):189–209. https://doi.org/10.1080/026990501300005659CrossRefPubMed

39.

Nazarov S, Manuwald U, Leonardi M et al (2019) Chronic diseases and employment: which interventions support the maintenance of work and return to work among workers with chronic illnesses? A systematic review. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph16101864CrossRefPubMedPubMedCentral

Title: Complete response to therapy: why do primary central nervous system lymphoma patients not return to work?
Authors: Greta Wiemann
Milena Pertz
Thomas Kowalski
Sabine Seidel
Uwe Schlegel
Patrizia Thoma
Publication date: 01-08-2020
Publisher: Springer US
Keyword: Lymphoma
Published in: Journal of Neuro-Oncology / Issue 1/2020
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-020-03587-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Complete response to therapy: why do primary central nervous system lymphoma patients not return to work?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Melanoma brain metastases: is it time to eliminate radiotherapy?

Pediatric primary central nervous system tumors registry in Thailand under National Health Security Office schemes

Autoimmune disease-related primary CNS lymphoma: systematic review and meta-analysis

Temozolomide and seizure outcomes in a randomized clinical trial of elderly glioblastoma patients

Giant intracranial germinoma

Stereotactic reirradiation with temozolomide in patients with recurrent aggressive pituitary tumors and pituitary carcinomas