Our study included a total of 250 patients, with median age of 42 years (range 33-54 years) and 169/250 (67.6%) males. The vast majority (91.6%) had received a formal education. Urdu was the most common mother-tongue (30.8%), with Sindhi (18.8%) and Punjabi (14.8%) being others. Most patients (82%) were married, and around half of them (54%) lived in extended families. About one-third (30.8%) of patients reported being their family’s head/chief decision-makers. However, half (50.8%) of patients were not currently working, and two-thirds (66.8%) had non-working spouses. The median monthly household income was PKR 60000 (30000-100000)/USD 374 (187‐623). The patients’ sociodemographic characteristics are shown in Table 1 of the previous publication by the authors based on analysis of the same sample .
Participants’ Medical History and Tumor Characteristics
Hypertension (HTN: 24%) and type 2 diabetes mellitus (T2DM: 14.8%) were the most common comorbids, while 6% of patients currently smoked and 2.8% currently used smokeless tobacco. The commonest brain tumors were glioma (46.8%), meningioma (21.2%), and schwannoma (4.8%). Most patients underwent only a biopsy (78%), while 4.4% underwent total resection only. Adjuvant therapy was received 39.2% of patients. Around half (55.2%) of patients were still receiving treatment for their brain tumor, while the rest had completed treatment (Table 1). A family history of brain or other cancers were reported by 4.8% and 16% of patients, respectively, and only 4% of patients reported a family history of depression.
Resilience, Social Support, and Mental Health
Most patients reported high social support (97.6%) and normal depression (90%) and anxiety (91.6%) scores. The mean resilience was 83.71 ± 9.32, which is categorized as high (Table 2).
Quality of Life
The mean global QoL score was 75.73. The values of the five functioning scales ranged from 81.2 (role functioning) to 87.93 (social functioning). In the symptom scales, pain had the highest score (29.7), followed by appetite loss (26.13), insomnia (25.06), and financial difficulties (21.06). The two worst symptoms on the BN-20 symptom scale were headache (21.46) and weakness (18.40). These are detailed in Table 3.
Variables associated with QoL outcomes
In the first step of the GLM-MANOVA, the association between the independent variables (detailed in Methods: Statistical Analysis) and the dependent variables (15 scales of QLQ-C30) was investigated (one-factor model). On the one-factor model, 17 variables were associated with the overall outcome of QLQ-C30 with p < 0.20. These 17 variables were entered into the multifactor model analysis. Variables significantly associated on the multifactor model were age, type of intervention, adjuvant therapy, use of feeding tube, use of a urine catheter, resilience, depression, anxiety and social support (all p < 0.05). In the one-factor model with QLQ-BN20 as the outcome, 17 variables were associated with the overall outcome on QLQ-BN20 at p < 0.20. In the multifactor model, role in family, smoking, smokeless tobacco use, family history of cancer other than brain, resilience, depression, anxiety and social support remained significantly associated (p < 0.05). Results of the GLM-MANOVA are shown in Table 4.
Linear Regression Analysis
On univariate linear regression with global QoL as the dependent variable, no formal schooling (Beta Coefficient: -8.59), no household income (-9.06) or PKR 6000-25,000 (-11.77), hypertension (-5.35), current use of smokeless tobacco (-15.12), current use of a urine catheter (-22.85), low social support (-14.98), mild (-18.40) or symptomatic (-26.41) depression, and mild (-20.03) or symptomatic (-15.6) anxiety, were significantly negatively associated with QoL. Only resilience (0.67) was significantly positively associated with QoL. Age, T2DM, and status of cancer treatment demonstrated a p-value < 0.25 on univariate analysis and were thus included in the multivariable model.
On multivariable linear regression, having no income (-10.96), an income of PKR 6000-25,000 (-10.42) or PKR 25,000-40,000 (-7.82), having hypertension (-5.77), and currently using a urine catheter (-15.33) were significantly negatively associated with global QoL. Having low social support (-28.16) was also inversely associated with global QoL, while resilience (0.28) demonstrated a significant positive association. In addition, suffering from mild (-9.88) or symptomatic (-17.59) depression, or mild anxiety (-7.11), was also associated with a poorer QoL (Table 5).