Relationships between executive functioning and health-related quality of life in adult survivors of brain tumor and matched healthy controls

ABSTRACT

Introduction

Few studies have considered health-related quality of life (HRQOL) as a primary outcome measure in adult survivors of primary brain tumor (PBT), and fewer still have studied the cognitive factors that may influence it. Research suggests that executive functions (EFs) are associated with HRQOL, but there is scant evidence to support this. The present study was conducted to (1) extend prior findings about HRQOL limitations in a sample of stable, long-term adult survivors of PBT, (2) investigate the associations between objective/reported EFs and HRQOL, and (3) identify the EFs that contribute most to HRQOL.

Method

We recruited 40 survivors of PBT (> 2 years post-treatment) and 40 matched healthy controls. Participants completed an objective EF assessment (inhibition, working memory, shifting, and rule detection) and two self-report questionnaires probing EFs (Behavior Rating Inventory of Executive Function-Adult) and HRQOL (Medical Outcomes Study Short-Form 36). Participants’ relatives completed observer-rated versions of these questionnaires.

Results

Patients’ objective EF performances were relatively intact. However, patients and caregivers reported significantly more problems than healthy controls and their relatives, for both EFs and HRQOL. There were only negligible links between objective EFs and HRQOL, whereas numerous associations were found between reported EFs and HRQOL components. ANCOVA models revealed that specific reported EF processes contributed to both the physical and mental components of HRQOL, regardless of group.

Conclusions

From a clinical point of view, this study demonstrates that even several years after end of treatment, adult PBT survivors experience substantial problems across different HRQOL domains. HRQOL assessment should therefore be part of the long-term follow-up of PBT survivors, and clinicians should consider EF limitations when designing appropriate survivorship care plans. These findings indicate that cognitive interventions targeting EFs could improve HRQOL.

KEYWORDS:

• Executive functions
• Health-related quality of life
• Primary brain tumor
• Survivorship
• Patient-reported outcomes

Acknowledgments

We wish to thank the participants, families, and informants for their implication in this study. We warmly thank Elizabeth Portier for her English language editing assistance.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Participants signed informed consent regarding publishing their data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

The present study received French regulatory ethical approval (Comité de Protection des Personnes Ouest II, no. 2015/27, ID-RCB no. 2015-A01192-47) which includes the International Review Board Authorisation (No. NCT02693405). The Angers University Hospital was the study’s promoter.

Additional information

Funding

This study was supported by the l'Institut National du Cancer (INCa), under grant number [SHSESP14- 14-041].