Abstract
Background
Little is known about the symptoms glioma patients experience in the year before diagnosis, either or not resulting in health care usage. This study aimed to determine the incidence of symptoms glioma patients experienced in the year prior to diagnosis, and subsequent visits to a general practitioner (GP).
Methods
Glioma patients were asked to complete a 30-item study-specific questionnaire focusing on symptoms they experienced in the 12 months before diagnosis. For each indicated symptom, patients were asked whether they consulted the GP for this issue.
Results
Fifty-nine patients completed the questionnaires, 54 (93%) with input of a proxy. The median time since diagnosis was 4 months (range 1–12). The median number of symptoms experienced in the year before diagnosis was similar between gliomas with favourable and poor prognosis, i.e. 6 (range 0–24), as were the five most frequently mentioned problems: fatigue (n = 34, 58%), mental tiredness (n = 30, 51%), sleeping disorder (n = 24, 41%), headache (n = 23, 39%) and stress (n = 20, 34%). Twenty-six (44%) patients visited the GP with at least one issue. Patients who did consult their GP reported significantly more often muscle weakness (11 vs 3, p = 0.003) than patients who did not, which remained significant after correction for multiple testing, which was not the case for paralysis in hand/leg (10 vs 4), focussing (11 vs 6) or a change in awareness (9 vs 4).
Conclusions
Glioma patients experience a range of non-specific problems in the year prior to diagnosis, but only patients who consult the GP report more often neurological problems.
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References
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403
Rasmussen BK, Hansen S, Laursen RJ et al (2017) Epidemiology of glioma: clinical characteristics, symptoms, and predictors of glioma patients grade I-IV in the the Danish Neuro-Oncology Registry. J Neurooncol 135(3):571–579
Posti JP, Bori M, Kauko T et al (2015) Presenting symptoms of glioma in adults. Acta Neurol Scand 131(2):88–93
Snyder H, Robinson K, Shah D, Brennan R, Handrigan M (1993) Signs and symptoms of patients with brain tumors presenting to the emergency department. J Emerg Med 11(3):253–258
Salander P, Bergenheim AT, Hamberg K, Henriksson R (1999) Pathways from symptoms to medical care: a descriptive study of symptom development and obstacles to early diagnosis in brain tumour patients. Fam Pract 16(2):143–148
Frankel SA, German WJ (1958) Glioblastoma multiforme; review of 219 cases with regard to natural history, pathology, diagnostic methods, and treatment. J Neurosurg 15(5):489–503
Scott GM, Gibberd FB (1980) Epilepsy and other factors in the prognosis of gliomas. Acta Neurol Scand 61(4):227–239
Moots PL, Maciunas RJ, Eisert DR, Parker RA, Laporte K, Abou-Khalil B (1995) The course of seizure disorders in patients with malignant gliomas. Arch Neurol 52(7):717–724
Lowry JK, Snyder JJ, Lowry PW (1998) Brain tumors in the elderly: recent trends in a Minnesota cohort study. Arch Neurol 55(7):922–928
Liigant A, Haldre S, Oun A et al (2001) Seizure disorders in patients with brain tumors. Eur Neurol 45(1):46–51
Bussiere M, Hopman W, Day A, Pombo AP, Neves T, Espinosa F (2005) Indicators of functional status for primary malignant brain tumour patients. Can J Neurol Sci 32(1):50–56
Chang EF, Potts MB, Keles GE et al (2008) Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg 108(2):227–235
Bauman G, Fisher B, Watling C, Cairncross JG, Macdonald D (2009) Adult supratentorial low-grade glioma: long-term experience at a single institution. Int J Radiat Oncol Biol Phys 75(5):1401–1407
van Breemen MS, Rijsman RM, Taphoorn MJ, Walchenbach R, Zwinkels H, Vecht CJ (2009) Efficacy of anti-epileptic drugs in patients with gliomas and seizures. J Neurol 256(9):1519–1526
Iuchi T, Hasegawa Y, Kawasaki K, Sakaida T (2015) Epilepsy in patients with gliomas: incidence and control of seizures. J Clin Neurosci 22(1):87–91
Duhrsen L, Sauvigny T, Ricklefs FL et al (2019) Seizures as presenting symptom in patients with glioblastoma. Epilepsia 60(1):149–154
Yuile P, Dent O, Cook R, Biggs M, Little N (2006) Survival of glioblastoma patients related to presenting symptoms, brain site and treatment variables. J Clin Neurosci 13(7):747–751
Ekpene U, Ametefe M, Akoto H et al (2018) Pattern of intracranial tumours in a tertiary hospital in Ghana. Ghana Med J 52(2):79–83
Ozawa M, Brennan PM, Zienius K et al (2018) Symptoms in primary care with time to diagnosis of brain tumours. Fam Pract 35(5):551–558
Mortensen SJ, Bjerrum SN, Hedegaard SF, Tietze A, Gottrup H, von Oettingen G (2018) The role of computed tomography in the screening of patients presenting with symptoms of an intracranial tumour. Acta Neurochir 160(4):667–672
Litofsky NS, Farace E, Jr Anderson F, Meyers CA, Huang W, Jr Laws ER (2004) Depression in patients with high-grade glioma: results of the Glioma Outcomes Project. Neurosurgery 54(2):358–366 discussion 366–7
Ravn Munkvold BK, Sagberg LM, Jakola AS, Solheim O (2018) Preoperative and postoperative headache in patients with intracranial tumors. World Neurosurg 115:e322–e330
Burks JD, Bonney PA, Glenn CA et al (2016) Symptom resolution in infiltrating WHO grade II–IV glioma patients undergoing surgical resection. J Clin Neurosci 31:157–161
Hamilton W, Kernick D (2007) Clinical features of primary brain tumours: a case-control study using electronic primary care records. Br J Gen Pract 57(542):695–699
Kernick D, Stapley S, Goadsby PJ, Hamilton W (2008) What happens to new-onset headache presented to primary care? A case-cohort study using electronic primary care records. Cephalalgia 28(11):1188–1195
Schmidt-Hansen M, Berendse S, Hamilton W (2015) Symptomatic diagnosis of cancer of the brain and central nervous system in primary care: a systematic review. Fam Pract 32(6):618–623
Litofsky NS, Farace E, Anderson F Jr, Meyers CA, Huang W, Laws ER Jr (2004) Depression in patients with high-grade glioma: results of the Glioma Outcomes Project. Neurosurgery 54(2):358–366
World Health Organization. International classification of functioning, disability and health (ICF); 2015. https://www.who.int/classifications/icf/. Accessed 16 Dec 2015
CBS (2010) Zelfgerapporteerde medische consumptie, gezondheid en leefstijl. Den Haag/Heerlen: CBS. https://www.scp.nl/Onderzoek/Bronnen/Beknopte_onderzoeksbeschrijvingen/Permanent_onderzoek_naar_de_leefsituatie_POLS. Accessed 27 Dec 2018
Peeters MC, Dirven L, Koekkoek JA, Numans ME, Taphoorn MJ (2019) Prediagnostic presentations of glioma in primary care: a case-control study. CNS Oncol 8(3):Cns44
Ohayon MM (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6(2):97–111
Manzoni GC, Stovner LJ (2010) Epidemiology of headache. Handb Clin Neurol 97:3–22
Wiegner L, Hange D, Bjorkelund C, Ahlborg G Jr (2015) Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care—an observational study. BMC Fam Pract 16:38
Gjesdal S, Holmaas TH, Monstad K, Hetlevik O (2016) GP consultations for common mental disorders and subsequent sickness certification: register-based study of the employed population in Norway. Fam Pract 33(6):656–662
Frese T, Druckrey H, Sandholzer H (2014) Headache in general practice: frequency, management, and results of encounter. Int Sch Res Not 2014:169428
van Kessel E, Baumfalk AE, van Zandvoort MJE, Robe PA, Snijders TJ (2017) Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment. J Neurooncol 134(1):9–18
Bosma I, Vos MJ, Heimans JJ et al (2007) The course of neurocognitive functioning in high-grade glioma patients. Neuro-oncology 9(1):53–62
Paganini-Hill A, Chao A (1993) Accuracy of recall of hip fracture, heart attack, and cancer: a comparison of postal survey data and medical records. Am J Epidemiol 138(2):101–106
Dawson EG, Kanim LE, Sra P et al (2002) Low back pain recollection versus concurrent accounts: outcomes analysis. Spine 27(9):984–993 discussion 994
Walter FM, Penfold C, Joannides A et al (2019) Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences. Br J Gen Pract 69(681):e224–e235
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Peeters, M.C.M., Dirven, L., Koekkoek, J.A.F. et al. Prediagnostic symptoms and signs of adult glioma: the patients’ view. J Neurooncol 146, 293–301 (2020). https://doi.org/10.1007/s11060-019-03373-y
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DOI: https://doi.org/10.1007/s11060-019-03373-y