The urgent need to redefine quality of life in patients with low-grade glioma

For a long time, oncological considerations prevailed in patients with low-grade glioma (LGG), the main goal being to increase the progression-free survival and overall survival. Thanks to a paradigmatic shift based on early and maximal surgical resection(s) with (possibly delayed) adjuvant medical therapies, overall survival is now beyond 20 years. Functional considerations, however, received less attention. In most studies, only standard neurological examinations were carried out to search for motor and/or language deterioration, optionally with a rough evaluation of major cognitive dysfunctions (e.g. using Mini Mental State Examination) which could have a substantial negative impact on autonomy. Yet, patients with LGG are usually young and enjoy an active life at the time of diagnosis, and they have currently a life expectancy about one generation: they should thereby have the capacities to make long-lasting projects. To this end, there is an urgent need to redefine the concept of quality of life in these patients who will live with a chronic tumoral disease for many years/decades, by integrating more subtle criteria. It currently seems difficult to be content with the sole maintenance of basic neurological functions critical for survival but not enabling to build a more fulfilling life. Here, the purpose is to take into consideration higher-order cognitive (including metacognitive), behavioral, psychological, sexual, familial, socio-professional, and creative aspects. Assessment of QoL should be refined according to the wishes of each human being living with a LGG, based on his/her own conception of what should be his/her long-term future despite an incurable disease.