Background 

Glioblastoma multiforme (GBM) is an aggressive brain tumor. Patients commonly rely on family caregivers for physical and emotional support. We previously demonstrated that caregiver mastery measured shortly after diagnosis was predictive of GBM patient survival, corrected for known predictors of survival (n = 88).

Objective 

The aims of this study were to verify the contribution of caregiver mastery and investigate the added value of mastery over other predictors to predict 15-month survival.

Methods 

Data collected for a longitudinal study (NCT02058745) were used. Multivariable Cox regression analyses were performed for models with known clinical predictors (patient age, Karnofsky Performance Status, type of surgery, O6-methylguanine-DNA-methyltransferase promotor methylation status), with and without adding caregiver mastery to predict mortality. The added value of each model in discriminating between patients with the lowest and highest chances of survival at 15 months was investigated through Harrell's concordance index.

Results 

In total, 41 caregiver-patient dyads were included. When evaluating solely clinical predictors, Karnofsky Performance Status and patient age were significant predictors of mortality (hazard ratio [HR], 0.974; 95% confidence interval [CI], 0.949–1.000; and HR, 1.045; 95% CI, 1.002–1.091, respectively). Adding caregiver mastery, these clinical predictors remained statistically significant, and mastery showed an HR of 0.843 (95% CI, 0.755–0.940). The discriminative value improved from C = 0.641 (model with known clinical predictors) to C = 0.778 (model with mastery), indicating the latter is superior.

Conclusions 

We confirm that caregiver mastery is associated with GBM patient survival.

Implications for Practice 

Incorporating support and guidance for caregivers into standard care could lead to benefits for caregiver well-being and patient outcomes.

中文翻译：

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家庭照顾者掌握水平在预测胶质母细胞瘤患者生存中的附加值：一项验证研究

背景 

多形性胶质母细胞瘤 (GBM) 是一种侵袭性脑肿瘤。患者通常依赖家庭照顾者提供身体和情感支持。我们之前证明，诊断后不久测量的护理人员掌握程度可预测 GBM 患者的存活率，并针对已知的存活预测因子进行校正(n = 88)。

客观的 

本研究的目的是验证看护者掌握程度的贡献，并调查掌握程度相对于其他预测因素在预测 15 个月生存率方面的附加值。

方法 

使用为纵向研究 (NCT02058745) 收集的数据。对具有已知临床预测因子（患者年龄、Karnofsky 表现状态、手术类型、O6-甲基鸟嘌呤-DNA-甲基转移酶启动子甲基化状态）的模型进行多变量 Cox 回归分析，添加和不添加护理人员掌握程度以预测死亡率。通过 Harrell 一致性指数研究了每个模型在区分15 个月时生存机会最低和最高的患者方面的附加值。

结果 

总共包括 41 对照顾者-患者。当仅评估临床预测因子时，Karnofsky 表现状态和患者年龄是死亡率的重要预测因子（风险比 [HR]，0.974；95% 置信区间 [CI]，0.949–1.000；HR，1.045；95% CI，1.002–1.091 ， 分别）。加上护理人员的掌握程度，这些临床预测因素仍然具有统计学意义，掌握程度显示 HR 为 0.843（95% CI，0.755–0.940）。判别值从C = 0.641（具有已知临床预测因子的模型）提高到C = 0.778（具有掌握的模型），表明后者更优。

结论 

我们确认护理人员的熟练程度与 GBM 患者的存活率相关。

实践意义 

将对护理人员的支持和指导纳入标准护理可能会有益于护理人员的健康和患者的治疗效果。