Table 1 Summary of characteristics of studies included in review (N = 48)
From: Quality of life outcomes in acoustic neuroma: systematic review (2000–2021)
Author | Quality Index (QI)a | Sample | Measure/s of QoL | Timing | Grouping factors | Finding |
|---|---|---|---|---|---|---|
Relation to Sample Characteristic/Symptoms (N = 7; mean QI= 15.14) | ||||||
Prummer [24] | 17 | N = 802, Acoustic Neuroma Association members N = 258, non-ANA from a single clinical site | PANQOL | Not explicitly stated Presentation January 2015–March 2017, so within 2 years | ANA membership | ANA members significantly: Younger (59 vs 60 years), larger tumour size, and Sig more women (72 vs 55%), microsurgery (57 vs 21%), radiation (21 vs 8%), hearing loss (95 vs 88%), tinnitus (80 vs 73%), dizziness (78 vs 64%), headache (56 vs 45%), and facial paralysis (37 vs 12%). Sig less watch and wait (16 vs 65%) ANA Sig lower PANQOL scores for: hearing (OR: 0.47, 95% CI: 0.35–0.64), balance (OR: 0.51, 95% CI: 0.38–0.70), pain (OR: 0.63, 95% CI: 0.46–0.86), facial function (OR: 0.58, 95% CI: 0.42–0.80), energy (OR: 0.44, 95% CI: 0.32–0.59), anxiety (OR: 0.54, 95% CI: 0.40–0.74), general QoL (OR: 0.72, 95% CI: 0.53–0.98), Total QOL (OR: 0.40, 95% CI: 0.30–0.55 |
Broomfield [25] | 10 | N = 598 BANA members | Online survey of: overall experience of diagnosis and/or treatment | 78.9%—since 2000, 17.2%—in 1990s 3.1%—1980s 0.9%—pre-1980 10—not reported | N/A | Most common symptoms at diagnosis: hearing loss (84%), unilateral tinnitus (40%), imbalance (51%). Information received: 39% just the right amount of information about all ‘management options’, 32% ‘not enough information’. Treatment after-effects (QoL overall): ‘a lot better’ (11%), ‘a little better’ (7%), ‘unchanged’ (25%), ‘a little worse’ (38%), and ‘a lot worse’ (19%). 61% respondents continued in the same job. 65% return to social life, hobbies, sports impaired. Overall experience: Treatment as ‘much better than expected’ (20%), ‘a little better’ (15%), ‘about the same’ (27%), ‘a little worse’, (22%) and ‘much worse’ (16%) |
Oddon [26] | 16 | N = 26 active surveillance 14 tumour growth 12 no growth 0 tumour shrinkage | PANQOL SF-36 | Mean 25 months (range 6–72) | Presence of vertigo | Vertigo or dizziness = poorer QoL on SF-36 (Social Functioning, Role-Emotional) and PANQOL scale (Balance, Energy) Psychological factors (QoL, depression, and self-esteem) do not seem to influence decision-making in this patient population |
AL-Shudifat [27] | 18 | N = 395 surgically treated | SF-36 | Range 11 to 32 years | Age (< 64, ≥ 65) Gender Tumour size | All SF-36 domains (except pain) showed moderate decrease, reaching a 30% reduction postoperatively in comparison with Swedish norms. The pain score was showed an increase (mean= 1.0169) compared to norms. No significant differences were shown between age groups Only tumour diameter and taste loss showed significant correlations with both physical and mental component scores |
Iyer [28] | 14 | N = 83 surgically treated 19 middle cranial fossa 64 translabyrinthine | SF-36 GBI | Not reported | Hearing preservation | QoL reduced in both surgery groups. Mean GBI score for translabyrinthine group was − 7.5 (95% CI: − 2.5 to − 13.5) and middle fossa group − 4 (CI: 213.5 to 5.5). GBI domains: general aspects reduced, social improved, physical no change. GBI scores if hearing preserved were similar SF-36 sig reduction in social function scores vs norms (p=0.035). Translabyrinthine similar as social function only domain to show sig deterioration (p=0.007). Middle fossa no sig reductions. SF-36 scores no sig difference between groups, apart from social function (p =0.015; better in middle fossa group) |
Lassaletta [29] | 15 | N = 70 surgically treated | GBI | Up to 7 years post | Facial functioning | No sig differences found in GBI between those with and those without facial dysfunction Reduced QoL was associated with post-operative pain |
Lloyd [30] | 16 | N = 165 active surveillance | SF-36 | Up to 19 years | Hearing and dizziness | Physical component scores sig lower than norms. Mental component scores sig above norms Dizziness and age were strong predictors of physical component (p’s= 0.0001) Dizziness and tinnitus were sig predictors of mental component (p = 0.0004 and 0.027). However, only small amount of variance explained |
Comparisons to normative data and/or controls (N = 16; mean QI= 18.38) | ||||||
Broomfield [31] | 21 | N = 334 (SF-36) (369 QoL-2) surgically treated Translabyrinthine approach | SF-36 Generic postoperative QoL scale (Qol-2) | Minimum 5 years | Comparison to normative data | SF-36 all scores diff sig from norms except ‘role emotional’ Largest difference was physical function, followed by role-physical, body pain, and general health Mental component score: tumour size ≥ 4 cm likely to have 3.4 less score than tumour o< 1 cm (p=0.037). Little evidence for effect of small tumour sizes No evidence for tumour size effect on the physical component score Improved in mental component score associated with increased time since surgery (age an tumour size accounted for) QOL-2: patients reported an improvement (“a lot” or “a little” better) in their overall quality of life (24%) and overall health (20.4%) |
Cheng [32] | 15 | N = 98 surgically treated | SF-36 | Minimum 6-months | Comparison to normative data Also by gender, age, tumour size, operative approach | Compared to norms: Lower physical function, role-physical, general health, vitality, social function, role-emotional, and mental health Higher for body pain (i.e. less pain reported by patients) Only role-physical significant No sig diffs for gender, age, tumour size or surgical approach |
Tufarelli [33] | 21 | N = 386 surgically treated | SF-36 | Mean 4.01 years SD 2.39 years post-op | Comparison to normative data | 231 (59.8%) = asymptomatic post-surgery, 155 (40.15%) = very disabling symptom/s Hearing loss as most disabling symptom SF-36 scores lower than normal population particularly for role physical, role emotional, and physical function (differentials all > 10) Women produced sig lower scores than men age had sig impact on physical functioning (≤ 45 years had sig higher score than patients > 45 years) Time interval from surgery did not influence QoL |
Baumann [34] | 19 | N = 42 surgically treated | SF-36 | Median 3.1 years (range 1.0–5.3) | Comparison to normative data | Significantly lower SF-36 scores than normative sample on all scales with exception of vitality and mental health scales |
Sun [35] | 15 | N = 24 surgically treated | SAS SDS SF-36 | 1 year post-op | Comparison to normative data | No sig difference to norms for anxiety or depression; 2 (9.5%) patients scores > cut-offs for each Sig higher scores on general health and vitality dimensions of the SF-36 compared to norms No significant differences in other dimensions observed |
Godefroy [36] | 19 | N = 17 surgically treated with rotatory vertigo | SF-36 | Pre-operative and 3 and 12-month post-operative | Comparison to normative data | All SF-36 scores below norms at pre, 3-month and 12-month follow-up across scales Improvements though none sig pre-op to 3 months Sig improved scores 12 months post-op for all except body pain and vitality |
Browne [37] | 13 | N = 119 AN surgically treated | SF-36 | Not reported | Comparison to normative data Comparison to illness group controls (e.g. diabetes, dermatitis) | AN report impaired overall QoL compared to general population controls and other chronic illness groups AN patients reported better physical and general health outcomes Hearing was the most frequent difficulty post- surgery, and this impacted social functioning Most AN patients named at least one positive outcome from their illness AN patients who had facial difficulties following surgery were less likely to report positive outcomes |
Betchen [38] | 19 | N = 101 surgically treated | SF-36 | Mean 3.2 years (range 6 months to 7 years) | Comparison to normative data (x3 sets) | Compared to Ware’s norms: Lower scores on all scales except vitality Sig lower role physical, role emotional, and body pain Compared to Jenkinson norms: Significant lower in current study for physical function, role physical, social function, and body pain Compared with McDowell norms: Sig lower score on body pain, but sig higher scores for general, physical functioning, role physical, role emotional, and vitality |
daCruz [39] | 13 | N = 72 surgically treated | SF-36 | > 18 months | Comparison to healthy sex- and age-matched controls | SF-36 scores were lower than controls for physical function, role-physical, body pain, general health; social functioning, role emotional, mental health Only the score for vitality was higher than that of controls. Significance of differences not reported. Gender, age, tumour size, and surgical approach did not sig impact QoL scores |
Scheich [40] | 19 | N = 86 surgically treated | SF-36 | > 6 months post-op | Comparison to normative data Comparison to those with hearing loss | Norms: Sig lower scores all categories except bodily pain. Hearing loss: Sig lower scores for social function and role-emotional; Sig higher score for body pain |
Nicoucar [41] | 21 | N = 72 surgically treated | SF-36 | Mean 7.6 years (range 6 months–19 years) | Comparison to normative data (x3 sets) Comparison to surgical controls (x2 sets) | Sig lower scores than all three normative data sets for role-emotional, physical functioning, social functioning, and vitality Sig lower than one study on body pain and 2 studies for mental health Compared to surgical norms: Lower vitality compared to both surgical groups, whilst comparison to one study also showed higher body pain, but worse mental health, physical function, and social functioning |
Martin [42] | 20 | N = 76 surgically treated | SF-36 | Mean 18 months Interquartile range 19 months | Comparison to normative data | Sig lower scores than norms for General health, vitality, role-physical, physical functioning, social functioning Time post-op (< 12 months >12 months) did not impact findings Larger tumours = lower physical function Older patients= lower physical and role-physical Women = lower vitality, physical functioning, body pain Number postoperative symptom was associated with all SF-36 scales except vitality and physical functioning (scores lower if more symptoms) |
Kelleher [43] | 21 | N = 54 29 active surveillance 19 surgery 6 SRS 2 died (unrelated) | SF-36 | Median 36.8 months (range 14–176) | Comparison to normative data | Active surveillance vs norms: No sig difference Surgery vs norms: Sig worse social function and role-physical |
Myrseth [44] | 18 | N = 189 (140 for analysis) 86 surgery 103 SRS | SF-36 GBI | Mean 6.7 years range, 1.5–13.0 | Comparison to normative data | GBI: Overall score for surgery sig lower than SRS Sig higher for SRS than surgery on “general and psychosocial health” No sig diffs for “social support” and “physical health status” SF-36: patients sig lower than norms for role-physical and social functioning Sig greater deviations below norms for surgery than SRS for physical functioning, role-physical, and role-emotional SRS means > surgical means all other categories, but not sig |
Myrseth [45] | 20 | N = 199 45 surgery 63 SRS 91 active surveillance | SF-36 GBI | Not reported | Comparison to non-patient controls | SF-36 sig below norms range 0.006 (bodily pain) to less than 0.001 (remaining categories) GBI negative benefit in general and physical sections and positive benefit in the social section Vertigo, sig assoc’d with reduced QOL across all SF-36 scales and general and physical parts of GBI. Tinnitus was associated with body pain, and unsteadiness with role physical and physical function |
MacAndie [46] | 20 | N = 42 Active surveillance Controls from clinic | SF-36 | Not reported | Comparison to matched controls from same clinic | QoL was comparable with an age- and sex-matched control group presenting with similar symptoms |
Changes within a treatment modality (N = 8; mean QI = 19.25) | ||||||
Turel [47] | 19 | N = 100 Surgically treated | SF-36 GBI | Pre versus 1 and 2 year follow-ups | Pre vs 1 and 2 years post | Preoperative—decrease in all SF-36 domains, then improved at 1 year in all cases 63–85% patients show minimum clinically important difference (MCID) in various SF-36 domains At 2 years SF-36 improvement sustained with further improvement in some domains. On GBI, 87% of patients reported improvement, 1% felt no change, and 12% reported deterioration |
Timmer [48] | 19 | N = 97 SRS (Gamma Knife) | SF-36 GBI | Pre vs post | Hearing and dizziness | SF-36 similar to norms (role physical and general health sig lower) and not correlated to age, gender, tumour size or radiation dose. Audio vestibular symptoms post-SRS correlated with decreased GBI and SF-36 scores Slight reduced GBI pre to post |
Varughese [49] | 17 | N = 45 SRS (Gamma Knife) Large tumour | SF-36 | Pre vs post treatment (mean 30.2 and 50 months post diag) | Diagnosis and Pre vs post | Significant improvements in body pain and general health, whilst social function was significantly reduced from pre to post treatment. Mental health reduced significant from diagnosis to treatment and then increased (non sigh) post treatment |
Wangerid [50] | 17 | N = 98 SRS (Gamma Knife) Small to medium tumour | EQ-5D | Median 104 months (11–165) | At end of the follow-up, mean QOL was calculated to 0.77 and median to 0.91 (1.0= best possible health state). Median score was 1.0 for each subcategories (mobility, self-care, daily activities, pain/discomfort, anxiety/depression) | |
Godefroy [51] | 23 | N = 41 Active surveillance | SF-36 | Mean 40 months (range 11–73 months) | Diagnosis vs follow-up | SF-36 scores slightly deteriorated except for social functioning, which was slightly improved Follow-up scores did not differ sig from baseline |
Breivik [52] | 23 | N = 186 Active surveillance (74 treated during follow-up) | SF-36 GBI | Medan 43 months (range 9–115 months; SD = 21.48 | Pre vs post treatment | Active surveillance: slight but sig trend to improved SF-36 vitality and role-emotional, and GBI general and physical dimensions Sig worse SF-36 Social functioning and GBI social dimension Treatment: small but sig worse SF-36 physical functioning and role-emotional; and improved GBI total, general, and physical aspects Examining symptoms, tumour volume, sex, age, and QOL: INCREASED vertigo related to reduced QOL through all dimensions in both questionnaires Tinnitus was associated with 1 GBI and 4 SF-36 subscales Females had sig lower values in both SF-36 and GBI (all scales) than men over time |
Fahy [53] | 14 | N = 51 surgically treated | GBI derivative | 1–3 years post-surgery | Pre vs post-op Relation to tinnitus | There was no statistically significant association of changes in tinnitus status and changes in the QoL post-op (P>0.05). |
Park [54] | 22 | N = 59 Post-SRS | SF-36 | 1-, 3-, 6-, 12-, and 18-month post-treatment | ≥ 6 months, n = 46 ≥ 12 months, n = 35 ≥ 18 months, n = 16 | No sig decline in QOL observed from baseline to any follow-up period SF-36 overall at baseline was 73, with range 70–77 across follow-ups |
Comparison between Treatment Modalities (N = 15; mean QI= 20.07) | ||||||
Nellis [55] | 18 | N = 216 98 surgery 118 active surveillance | RSES BDI VRQOL Overall QoL on a visual analogue scale (0–100, higher rating as more positive). | Post-diagnosis, pre-treatment decision | Choice to undergo resection vs active surveillance | No significant association between psychological factors (QoL, voice-related QoL depression, self-esteem) and decision to undergo surgery or pursue active surveillance VRQoL sig lower in patients with hearing loss, difficulty swallowing liquids or solids, change in voice, and headache (p < 0.05) |
Lodder [56] | 17 | N = 359 BANA members 185 surgery 94 SRS or SRT 17 surgery + SRT 63 active surveillance | PANQOL | Up to > 10 years follow-up | Treatment approach Length of follow-up | Composite QoL scores no significant group diff (p = 0.532: microsurgery 58 (SD=35), radiotherapy 56 (SD=18), surgery and radiotherapy 49 (SD= 14), observation only group 54 (SD 20) Composite QOL score different sig (p < 0.001) by follow-up: <6 years= 52 (SD =18), 6–10 years = 55 (SD =20) > 10 years = 65 (SD = 45) |
Robinett [57] | 22 | N = 279 157 surgery 79 active surveillance 43 SRT | PANQOL | Mean follow-up 7.9 years | Surgery, SRT, active surveillance Years follow-up (0–5, 6–10, > 10) | Composite QoL scores highest in SRT and lowest in active surveillance (means, 71, 73, 82), with SRT sig higher than the other two groups When time interval included, sig diff was only present at 0–5 years Within groups QoL sig reduced from 0–5 year to 6–10 years in SRT |
McLaughlin [58] | 23 | N = 186 98 active surveillance 49 SRS 39 surgery | PANQOL | Mean follow-up = 2.6 years | surgery vs SRS vs surveillance | Tumour size (mm) sig diff between groups: surveillance (8 ± 4.8), gamma (18 ± 5.9), surgery (22 ± 8.3) groups (p < 0.001) Speech recognition threshold and speech discrimination % sig better for surveillance vs gamma or surgery (p < 0.001) Hearing domain scores better for surveillance (62 ± 26) than surgery (47 ± 25) General and total domain scores were similar across groups, QoL scores for gamma and surgery were similar |
DiMaio [59] | 18 | N = 205 134 surgery 48 SRS or SRT 47 active surveillance | SF-36 | Pre vs post Surgery vs SRS/SRT vs active surveillance | SF-36 not sig diff between groups at baseline except for surgical with tumour > 3 cm, where scale scores were sig lower on role physical, vitality, social functioning, role-emotional, and the two dimensional scores (emotional and physical) SF-36 no change baseline to follow-up for surveillance and radiation groups SF-36 sig improved for surgical group (> 3 cm tumour) at 1.5 months and 24 months on composite mental and at 24 months on composite physical dimension Asked: “the single most important factor affecting QOL right now”—roughly one third (across all groups) reported hearing to be the most important factor | |
Myrseth [60] | 22 | N = 88 28 surgery 63 SRS 3 withdrew | SF-36 GBI | 1- and 2-year post-tx follow-up | Surgery vs SRS | SF-36 and GBI no sig diffs bw groups at baseline SF-36 did not change sig from baseline within any group nor did the groups differ sig. GBI non-sig trend to better scores in SRS group at 1 year Sig better GBI outcomes for gamma knife at 2 years on general, physical, and total scores (latter 2 positive for SRS and negative for surgery group) |
Pollock [61] | 24 | N = 82 36 surgery 46 SRS | SF-36 (refer to as HSQ) | Mean 42 months range 12–62 Assessed 3 and 12 months, and final follow-up | Surgery vs SRS | Sig changes in SF-36 for surgery group only 3 months: sig decline in SF-36 Physical function, role-physical, body pain, and physical composite Sig increases in social function and vitality 1 year: sig declines from baseline for physical function and body pain Final: Sig increase in mental health scale and mental composite score from 1 year, sig decrease in body pain from baseline |
Sandooram [62] | 20 | N = 33 15 surgery 18 active surveillance | SF-36 GBI | One- and 6-month post-op follow-up | Surgery vs active surveillance | SF-36: microsurgery sig increased vitality and health perception, and trend to better role- emotional from baseline to 6 months than active surveillance GBI: surgery sig increase in social support Score from baseline to 6 months compared to active surveillance |
Sandooram [63] | 21 | N = 165 102 surgery 42 active surveillance (AS) 10 SRS 6 AS then SRS 5 AS then surgery | GBI | Range 0.2–15 years | Pre vs post Comparison of Tx groups | Surgical deteriorated in QoL post- treatment Active surveillance QoL maintain life they had at initial presentation Trend towards poorer QoL post-surgery compared to active surveillance (p = .070) Slightly poorer QoL in SRS compared to active surveillance (p=0.121) There was no statistically significant difference SRS vs surgery Delayed surgery GBI total scores similar to surgical group Delayed SRS had better QoL compared to SRS |
Brooker [64] | 21 | N = 180 102 surgery 42 SRT 36 active surveillance | SF-12 GBI | ≤ 5 years post-op but > 6 months post | Surgery vs radiation vs surveillance | No sig diff SF-12 across microsurgery, radiation, and observation patients More deterioration GBI general well-being in microsurgery vs radiation patients More improvement in the GBI social support scale in microsurgery vs observation patients No sig group diffs on GBI total or physical health scores Number symptoms consistently predicts SF-12 and GBI scores |
Ning [65] | 23 | N = 100 50 translabyrinthine approach 50 retrosigmoid approach. | SF-36 | 1 month post-discharge | Surgical approach | retrosigmoid approach: sig higher social functioning, role-emotional, and mental health Translabyrinthine approach: sig higher body pain and vitality |
Rameh [66] | 15 | N = 101 surgically treated 59 translabyrinthine approach 42 retrosigmoid approach | SF-36 | Mean 5.9 years | Surgical approach | Both groups sig lower scores than norms Pain correlated most with poorer QoL but was the least frequent symptom reported Facial weakness not correlated with a poorer QOL |
Lin [67] | 22 | N =25 complete facial paralysis post-surgery 4 facial nerve repair during initial AN surgery 7 end-to-end nerve to hypoglossal anastomosis, 7 end-to-side with sural nerve, greater auricular nerve or interposition graft, 7 end-to-side facial nerve anastomosis with hyperglossal nerve | SF-36 | Mean 11.5 years Range 1–25 years | Comparison of nerve repair groupings | Patients in end-to-side interposition group had sig better QoL than those in end-to-end group for physical function( p = 0.04) and role-physical (p = 0.05) No other sig differences found |
Carlson [68] | 20 | N = 1288 229 no treatment selected 303 active surveillance 185 SRS 507 surgery 64 surgery + SRS | PANQOL | Mean = 5 years (SD= 7.3) | surgery vs radiation vs surveillance vs no treatment yet selected | Adjusted for covariates PANQOL total: highest for AS (65; 95% CI: 62–68), lowest surgery + SRS (56; 51–61) or no treatment selected (58; 55–62), intermediate for single treatment (microsurgery 60; 58–62); radiosurgery 61; 57–64) (p = 0.001) No sig differences between SRS + surgery and single treatment in total PANQOL scores for short (0–5 years), intermediate (6–10 years), or long-term (> 11 years) after adjust for baseline covariates (p’s > 0.05) |
Henzel [69] | 15 | N = 74 35 SRS 39 SRT | SF-36 | Median 50 months | SRS vs SRT in relation to tumour volume shrinkage | No sig differences observed after SRS/SRT. Previous operations and gender did not affect QoL (p > 0.05) Compared to German norms, all QoL domains were worse except for mental health |
Alternative approaches to QoL measurement (N = 2; mean QI= 12.0) | ||||||
Brooker [70] | 15 | N =21 8 surgery 4 SRS 5 SRT 2 Surgery +SRS 1 Surgery + SRT 1 active surveillance | Focus groups with thematic analysis | Mean = 3.7 years Range 1–11 years | N/A | Themes (subthemes): 1) Physical symptoms (hearing loss, balance problems, fatigue, tinnitus, fatigue assoc’d with hearing, balance and facial paralysis). 2) Psychological wellbeing (anger/frustration, depression, anxiety/uncertainty, body image, gratitude relief and psychological benefit). Higher psychological wellbeing assoc’d with less severe physical symptoms, and “received a good treatment outcome’ 3) Social wellbeing (social interactions were negatively impacted by hearing impairment and balance disturbance, but not facial paralysis) 4) Functional status (activities of daily living and occupational status) 5) Psychosocial factors influencing adjustment (individual differences and social support) |
Bateman [71] | 9 | N = 53 Post- surgical | Questions tied to WHO framework on impairment disability, handicap | >1 year Range 1–3 years | For handicap, social isolation emerged as a strong theme 15/43 (35%) were reluctant to attend large social gatherings Employment was also important with 7/43 (16%) | |