Longitudinal assessment of quality of life, neurocognition and psychopathology in patients with low-grade glioma on first-line temozolomide: a feasibility study

The treatment timing and choice after neurosurgical resection in patients with newly-diagnosed diffuse low-grade glioma (DLGG) remain controversial. Indeed, the effect of such treatments must be balanced with the possible side effects. This study evaluated the feasibility of longitudinal exhaustive quality of life (QoL) and neuropsychological assessments in patients with DLGG receiving first-line temozolomide. QoL, neurocognition and psychological disorders were assessed prospectively until disease progression, using testing, clinician-reported and self-reported questionnaires. The primary endpoint was the participation and adherence to this complete assessment at Baseline (before temozolomide initiation), month 6 and 12 of treatment and month 6 post-treatment. The QoL and neuropsychological changes over time also were described. Twenty-six of the 29 eligible patients were enrolled (participation rate: 89.7%, 95%CI 72.6-97.8). The adherence rate was 95.7% (95%CI 78.1-99.9; n=23 because 3 patients progressed in the first 12 months of treatment). Up to month 6 post-treatment, QoL and fatigue remained stable (EORTC QLQC30 and BN20, MFI-20); some specific symptoms were transitory. Both subjective (FACT-Cog) and objective (Z-scores of neurocognitive tests) neurocognitive outcomes remained stable or tended to improve. The percentage of patients with severe depression (BDI-II), anxiety (STAI-Y) or anger (STAXI-II) was stable over time. This prospective study demonstrated the feasibility of an exhaustive and longitudinal evaluation of QoL, neurocognition and psychological disorders, with high acceptability by patients with DLGG undergoing chemotherapy. First-line temozolomide seems to have limited short-term effects on QoL and neurocognition. These findings must be confirmed in the long-term and in a larger cohort.