Low-grade glioma patients without problems in daily functioning: a silent minority

Background: Low-grade gliomas (LGG) represent a heterogeneous group of primary brain tumors. Although all patients with LGG face similar challenges in coping with an incurable disease, interestingly, a subset of patients reports no (significant) problems in daily functioning and appear to resume their activities without changes. It is crucial to identify the group of patients that seem to cope so well, in order to find possible indications to help patients who do experience problems in daily functioning. Therefore, the present study aims to characterize the LGG patient group without problems in daily functioning.
Material and methods: 144 patients with LGG were included post-surgery and before adjuvant therapy. Patients were divided into two groups: patients with and without problems in daily functioning, based on the Patient Competency Rating Scale (PCRS). Demographic variables, disease characteristics (tumor location, tumor volume), anxiety, depression (HADS), coping (UCL) and general cognition (neuropsychological tests) were analysed to identify characteristics specific to the patient group without problems in daily functioning.
Results: Of the entire LGG cohort (mean age= 43 ± 12), 26.4% of the patients no (significant) problems in daily functioning. No significant differences were found for demographics (gender, age and educational level), disease characteristics and general cognition between patients with and without problems in daily functioning (p>0.05). However, patients without problems had significantly lower scores for anxiety (p<.01), depression (p<.01), avoidant (p=<.01) and passive coping (p<.001), compared to patients with problems in daily functioning.
Conclusion: More than a quarter of the patients with LGG experience no (significant) problems in daily functioning, after surgery and before adjuvant therapy. Notably, this subset of patients did not differ from patients with problems in daily functioning considering demographics, disease characteristics and cognitive functioning. However, the cohort of patients with no problems in daily functioning report lower levels of anxiety and depression, and use a more effective coping style, compared to patients who do experience problems in daily functioning. Therefore, it seems to be crucial addressing coping strategies, serving as a potential to help patients who do experience problems in daily functioning. Future research should focus on whether the patient group without problems in daily functioning continues to report zero complaints after adjuvant therapy, i.e. examining if an initial problem-free status serves as a protective factor during and after treatment.

Keywords: low-grade glioma, daily functioning, coping