Perceived Health Benefits in Vestibular Schwannoma Patients with Long-Term Postoperative Headache: Insights from Personality Traits and Pain Coping-A Cross-Sectional Study.

Postoperative headaches (POHs) following retrosigmoid microsurgery for vestibular schwannoma (VS) can significantly impact patients' perceived health benefits (PHBs). In this cross-sectional observational study, 101 VS patients were investigated. For the assessment of pain, the Rostock Headache Compendium (RoKoKo) and the German pain processing questionnaire (FESV) were used. The perceived health benefits (PHBs) were assessed by the Glasgow Benefit Inventory (GBI) and Big Five personality traits were measured using the Ten-Item Personality Inventory (TIPI-G). We showed that 55% of the participants experienced POHs, leading to a marked reduction in overall PHBs compared to those without POHs. The correlation analysis revealed an association between decreased PHBs and elevated levels of pain-related helplessness, depression, anxiety, and anger. Positive correlations were identified between PHBs and action-planning competence, cognitive restructuring, and the experience of competence. Low emotional stability and openness yielded associations with pain-related psychological impairment. Hearing loss and facial paresis did not exert a significant impact on PHBs. The study highlights the influence of pain-related coping strategies on PHBs in long-term POH patients. Thus, coping mechanisms and personality traits should be assessed even before surgery for post-surgery pain prevention. The limitations of this study include a relatively small sample size, potential biases introduced by the overrepresentation of female patients, and the use of an online survey methodology. In conclusion, this research highlights that the interplay between headaches, PHBs, and psychological factors is also relevant in VS patients undergoing microsurgery. Short-term psychological interventions should therefore be taken into account to improve post-surgery adaptive coping strategies.

Premorbid Psychological Factors Associated with Long-Term Postoperative Headache after Microsurgery in Vestibular Schwannoma-A Retrospective Pilot Study.

Associations between premorbid psychological factors and postoperative headache (POH) after microsurgical treatment via the retrosigmoid approach for vestibular schwannoma (VS) were investigated in this retrospective single-center study. A total of 101 VS patients completed the Rostock headache questionnaire (RoKoKo), the hospital and anxiety scale (HADS-D), and the screening for somatoform disorders (SOMS-2), all of which were used as short self-assessed questionnaires. Fifty-four patients with POH were compared with 47 non-POH patients in terms of premorbid psychological factors, somatization tendencies, and psychological burden using the chi2-test and Mann-Whitney U-test. Regression analyses were conducted to assess the weighted contribution of psychological and procedural factors to POH. In individuals with POH, mental ailments, preexisting headaches, premorbid chronic pain syndromes, and higher somatization tendencies were found to be significantly more common. POH was predicted by the number of premorbid psychosomatic symptoms, preexisting mental ailments, and premorbid chronic pain syndromes. Depression and anxiety were predicted by low emotional stability. Additionally, the number of premorbid psychosomatic symptoms predicted depression, anxiety, and overall psychological burden. It was observed that the reported symptoms of headache might fit into the classification of chronic postsurgical pain (CPSP) rather than being classified as secondary headaches after craniotomy. Premorbid psychological factors were found to play an important role in the emergence of POH in VS, particularly after microsurgery via the retrosigmoid approach. Therefore, it is suggested that psychological screening be incorporated into the treatment process.

Use of a Patient Information Leaflet on Oro-Dental Care During Radiotherapy.

PURPOSE: A patient information leaflet (PIL) on oral and dental care during radiotherapy was tested whether and at which time during therapy it would be helpful to increase the knowledge about the therapy and the resulting side effects and the management of these. Additionally, the participants' subjective perception of being well informed about the topic was examined. PARTICIPANTS AND METHODS: Surveys were conducted in August 2018-April 2019, at the University Hospitals Halle and Leipzig (Germany). The study population consisted of patients who were treated with radiotherapy in the head and neck region. Half of them received access to the PIL. The survey was conducted with three different versions of a printout questionnaire, which covered the relevant topics at three different times of therapy. The time the participants were surveyed depended on the time of their first therapy appointment. The items of the questionnaires tested their concrete knowledge and assessed the subjective perception of the level of information received. RESULTS: Of the 81 participants who received the PIL, 93.8% read it and 92.1% of them considered it helpful. The sample comprised 181 participants aged 32 to 85 years (M = 62.9), of which 135 were males, 42 were females, and 4 were unspecified. Evaluation showed a difference of 4.7%; 18.5%; and 13.6% in correct answers between subjects with and without access to the PIL before, during, and after the therapy, respectively. The assessment of the participants' personal information level was independent of their access to the PIL (chi-squared test, p = 0.89). CONCLUSION: Having access to the PIL increased participants' ability to answer the questionnaires correctly. Access to the PIL had no influence on the subjective feeling of being well informed.

Development and Validation of an Information Leaflet on Oral Care for Irradiated Patients.

PURPOSE: The aim of the study was to develop an optimally designed and comprehensibly formulated patient information leaflet (PIL) to improve patients' memory of information provided by physicians during a radiotherapy (head and neck area) consultation. This PIL was tested on unaffected probands for its usefulness in clinical practice. PATIENTS AND METHODS: A panel of experts compiled the main topics using Lawshe's content validity ratio. Flesch's Reading Ease Score (FRE) and the Baker Able Leaflet Design (BALD) index were adapted to appropriate values to determine text comprehensibility and graphic design. The evaluation involving unaffected participants (231 men, 380 women, 21 not specified; mean age = 32 ± 13.63 years, range = 18-79 years) was conducted based on three questionnaires for four groups of respondents with varying prior knowledge of the subject. When answering the questionnaires, only half the participants had access to the PIL. RESULTS: The expert panel included 59 out of 75 proposed topics. After reformulations, the FRE was adjusted from 38.5 to 51.4. The BALD index ranged from 24 to 26, depending on the printout edition. The evaluation of 632 unaffected participants indicated a difference in the correctly answered items that ranged from 2.86% to 30.76% between participants with and without access to the PIL. CONCLUSION: The general guidelines for the design of written patient information material were met. The evaluation of unaffected volunteers resulted in an advantage by answering the questionnaires after receiving the PIL. This study supports health practitioners in the development, design, and evaluation of written information material using scientific methods. An evaluation should be performed on affected patients.

Memory and Spatial Cognition in Breast Cancer Patients Undergoing Adjuvant Endocrine Therapy.

INTRODUCTION: It is generally accepted that estrogens play a protective role in cognitive function. Therefore, it can be expected that subtotal estrogen deprivation following aromatase inhibition will alter cognitive performance. METHODS: In a cross-sectional study we investigated 80 postmenopausal women with breast cancer. Memory and spatial cognition were compared across 4 treatment groups: tamoxifen only (TAM, n = 22), aromatase inhibitor only (AI, n = 22), TAM followed by AI ('SWITCH group', n = 15), and patients with local therapy (LT) only (surgery and radiation, n = 21). Duration of the 2 endocrine monotherapy arms prior to the assessment ranged from 1 to 3 years. The 'SWITCH group' received 2-3 years TAM followed by at least 1 year and at most 3 years of AI. Memory and spatial cognition were investigated as planned comparisons. Investigations of processing speed, attention, executive function, visuoconstruction and self-perception of memory were exploratory. RESULTS: With regard to general memory, AI patients performed significantly worse than the LT group (p = 0.013). Significant differences in verbal memory did not remain significant after p-value correction for multiple testing. We found no significant differences concerning spatial cognition between the groups. CONCLUSION: AI treatment alone significantly impairs general memory compared to the LT group.

Preventive brain radio-chemotherapy alters plasticity associated metabolite profile in the hippocampus but seems to not affect spatial memory in young leukemia patients.

BACKGROUND: Neuronal plasticity leading to evolving reorganization of the neuronal network during entire lifespan plays an important role for brain function especially memory performance. Adult neurogenesis occurring in the dentate gyrus of the hippocampus represents the maximal way of network reorganization. Brain radio-chemotherapy strongly inhibits adult hippocampal neurogenesis in mice leading to impaired spatial memory. METHODS: To elucidate the effects of CNS radio-chemotherapy on hippocampal plasticity and function in humans, we performed a longitudinal pilot study using 3T proton magnetic resonance spectroscopy ((1)H-MRS) and virtual water-maze-tests in 10 de-novo patients with acute lymphoblastic leukemia undergoing preventive whole brain radio-chemotherapy. Patients were examined before, during and after treatment. RESULTS: CNS radio-chemotherapy did neither affect recall performance in probe trails nor flexible (reversal) relearning of a new target position over a time frame of 10 weeks measured by longitudinal virtual water-maze-testing, but provoked hippocampus-specific decrease in choline as a metabolite associated with cellular plasticity in (1)H-MRS. CONCLUSION: Albeit this pilot study needs to be followed up to definitely resolve the question about the functional role of adult human neurogenesis, the presented data suggest that (1)H-MRS allows the detection of neurogenesis-associated plasticity in the human brain.

Patient information in radiation oncology: a cross-sectional pilot study using the EORTC QLQ-INFO26 module.

BACKGROUND: The availability of alternative sources of information, e. g. the internet, may influence the quantity and quality of information cancer patients receive regarding their disease and treatment. The purpose of the present study was to assess perception of information in cancer patients during radiotherapy as well as media preferences and specifically the utilization of the internet. METHODS: In a cross-sectional, single-centre study 94 patients currently undergoing radiotherapy were asked to complete two questionnaires. The EORTC QLQ-INFO26 module was used to assess the quality and quantity of information received by patients in the areas disease, medical tests, treatment, other services, different places of care and how to help themselves, as well as qualitative aspects as helpfulness of and satisfaction with this information. The importance of different media, in particular the internet, was investigated by a nine-item questionnaire. RESULTS: The response rate was n = 72 patients (77%). Patients felt best informed concerning medical tests (mean +/- SD score 79 +/- 22, scale 0-100) followed by disease (68 +/- 21). Treatment (52 +/- 24) and different places of care and other services (30 +/- 36 and 30 +/- 30, respectively) ranked last. 37% of patients were very satisfied and 37% moderately satisfied with the amount of information received, 61% wished more information. Among eight media, brochures, television and internet were ranked as most important. 41% used the internet themselves or via friends or family, mostly for research of classic and alternative treatment options. Unavailability and the necessity of computer skills were most mentioned obstacles. CONCLUSION: In a single-center pilot study, radiotherapy patients indicated having received most information about medical tests and their disease. Patients very satisfied with their information had received the largest amount of information. Brochures, television and internet were the most important media. Individual patient needs should be considered in the development of novel information strategies.

Cognitive Effects of Systemic Therapy in Patients with Breast Cancer.

Many patients with breast cancer complain about concentration and memory problems in connection with systemic therapy. A number of studies investigating the possible decrease in cognitive abilities were published in the 1980s. Numerous studies showed impaired performance of patients receiving chemotherapy. The results concerning profile, extent, and duration of cognitive impairments are, however, non-uniform. Increasing interest has been focused in the last years on effects of endocrine therapy on cognitive capacity - especially concerning the effects of the almost complete estrogen depletion caused by aromatase inhibitors. Often, the published studies did not evaluate particular effects of endocrine therapy without considering interference of cytotoxic treatment. Furthermore, the different endocrine medications (antiestrogens vs. aromatase inhibitors) were usually not regarded separately despite different mechanisms of action. Hence, the results of past investigations are also controversial. In the future, prospective trials with larger samples are necessary. Differentiation between chemotherapy and endocrine therapy is essential. Likewise, different types of endocrine therapy should be examined separately.

Quantification of human spatial behavior in an open field-locomotor maze.

To obtain and analyze the strategies of human spatial behavior, the Kiel Locomotor Maze, a maze-like analogue, was used. The Kiel Locomotor Maze automatically records different types of spatial memory errors, distances and rotation angles, decision time, and reaction times for each move. 18 patients with cerebral tumors within the frontal, temporal, or parietal lobes and 16 patients with Parkinson's disease were investigated with respect to "sense of direction." These parameters provide information beyond error scores. It was expected that patients with focal cortical lesions would be characterised by loss of directional sense whereas basal ganglia-related brain disease is characterised by preserved directional sense but poor memory for cue-defined target locations. Based on the neuropsychological theory of head-direction sense, especially the 1991 model of McNaughton, the functionality of storage and update of the head-direction sense may be reflected with the help of these parameters. "Direction sense" parameters provide information about success or failure of the acquisition of a spatial task much earlier than error scores.