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The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review

  • Review Article - Tumor - Glioma
  • Published:
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Abstract

Objective

For a long time, return to work (RTW) has been neglected in patients harboring a diffuse low-grade glioma (LGG). However, a majority of LGG patients worked at time of diagnosis. Moreover, these patients now live longer given current treatment paradigms, especially thanks to early maximal surgery.

Methods

We systematically searched available medical databases for studies that reported data on RTW in patients who underwent resection for LGG.

Results

A total of 30 studies were selected: 19 considered RTW (especially rate and timing) as an outcome and 11 used scales of health-related quality of life (HRQoL) which included work-related aspects. Series that considered RTW as a main endpoint were composed of 1014 patients, with postoperative RTW rates ranging from 31 to 97.1% (mean 73.1%). Timing to RTW ranged from 15 days to 22 months (mean 6.3 months). Factors related to an increased proportion of RTW were: younger age, better neurologic status, having a white-collar occupation, working pre-operatively, being the sole breadwinner, the use of awake surgery, and greater extent of resection. Female sex, older age, poor neurologic status, pre-operative history of work absences, slow lexical access speed, and postoperative seizures were negatively related to RTW. No studies that used HRQoL scales directly investigated RTW rate or timing.

Conclusions

RTW was scarcely analyzed in LGG patients who underwent resection. However, because they are usually young, with no or only mild functional deficits and have a longer life expectancy, postoperative RTW should be assessed more systematically and accurately as a main outcome. As majority (61.5–100%) of LGG patients were working at time of surgery, the responsibility of neurosurgeons is to bring these patients back to their previous activities according to his/her wishes. RTW might also be included as a critical endpoint for future prospective studies and randomized control trials on LGGs.

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Abbreviations

CT:

Chemotherapy

EOR:

Extent of resection

EORTC-QLQ-30:

European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire

FACT-Br:

Functional Assessment of Cancer Therapy—Brain

FU:

Follow-up

GTR:

Gross total resection

HRQoL:

Health-related quality of life

ISCO-08:

International Standard Classification of Occupations

LGG:

Low-grade glioma

NOS:

Newcastle-Ottawa Scale

NUP06:

Nomenclatura e classificazione delle unita professionali

OS:

Overall survival

PRISMA:

Preferred Reporting Items for Systematic reviews and Meta-Analyses

RT:

Radiotherapy

RTW:

Return to work

SF-36:

Medical Outcomes Study 36-item Short Form

STR:

Subtotal resection

WLQ:

Work limitations questionnaire

WRFQ:

Work-related functioning questionnaire

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

    Juan Silvestre G. Pascual

  2. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Agustin Fliche, 34295, Montpellier, France

    Hugues Duffau

  3. Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors, Institute of Functional Genomics, INSERM U1191, University of Montpellier, Montpellier, France

    Hugues Duffau

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  1. Juan Silvestre G. Pascual
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Contributions

Conception and design: HD. Acquisition of data: JSGP. Analysis and interpretation of data: all authors. Drafting the article: all authors. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: HD. Study supervision: HD.

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Correspondence to Hugues Duffau.

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Pascual, J.S.G., Duffau, H. The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review. Acta Neurochir 164, 2789–2809 (2022). https://doi.org/10.1007/s00701-022-05339-y

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