Vestibular Schwannoma Management: Comparing Trajectories of Health-Related Quality of Life and Patient-Reported Outcomes

Introduction: An understanding of the trajectory of patient-reported outcome measures (PROMs) based on different management strategies is an important element of patient counseling. In this study, we retrospectively assess prospectively collected PROM data to assess the impact of different management approaches for VS on patients' quality of life (QOL).

Methods: We conducted a single-center retrospective cohort study of patients seen with a diagnosis of VS from 2020 to 2023. Our prospective PROM collection system began in 2020; patients are administered the Patient Reported Outcomes Measure Information Set (PROMIS-10) and Function Assessment of Cancer Therapy-Brain (FACT-Br) questionnaires during each outpatient visit. Patients were included if they had both pre-treatment and at least one post-treatment PROM. PROMIS-10 scores were also converted to EQ5D-3L using published methods to compare health utility index values across approaches.

Results: A total of 347 patients were evaluated with a diagnosis of VS, among which 127 had both baseline and at least one posttreatment follow-up PROM response. Mean age was 52, and 78 (61.4%) subjects were female. Among the management approaches, 35 patients (28%) underwent observation, 51 (40.2%) underwent treatment. Treatment included retrosigmoid (RS; n = 30, 24%), translabyrinthine (TL; n = 51, 41%), and other (middle fossa approach or radiotherapy; n = 9, 7%). At the first visit, EQ5D scores significantly differed across all four approaches, with the lowest EQ5D observed in the RS approach. The most substantial EQ5D improvement was noted in the RS approach, followed by TL, whereas patients under observation experienced a decline in EQ5D. There was an increase in patients’ self-reported relevant symptom burden, with the most pronounced in patients who underwent RS; hearing (baseline: 1.33, last follow-up: 3.00), coordination (baseline: 0.63, last follow-up: 1.43) and headaches (baseline: 0.97, last follow-up: 3.71).

Conclusion: Vestibular schwannomas can profoundly impact patients’ quality of life, affecting hearing, balance, and other symptoms. This study highlights patients undergoing RS surgery exhibited the lowest EQ5D scores at their initial visit—potentially related to a selection bias for larger tumors. Despite an increased symptom burden, patients undergoing RS experienced the most significant improvement in EQ5D at their last follow-up ([Fig. 1]; [Tables 1] and [2]).

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024