QOL-04. Health-related quality of life decline precedes radiographic progression in malignant glioma: A retrospective study in bevacizumab-treated patients

Abstract OBJECTIVES Patients with malignant glioma often experience a decline in health-related quality of life (HRQoL) due to tumor-related neurological deficits and treatment-associated side effects. HRQoL assessment is increasingly recognized as an important tool in neuro-oncology. Bevacizumab is commonly used in progressive malignant gliomas, requiring frequent follow-up. This study aimed to investigate whether HRQoL assessments could detect disease progression earlier than MRI in patients receiving bevacizumab. METHODS We retrospectively analyzed 47 patients with WHO grade 4 malignant gliomas treated with bevacizumab at our institution and the National Cancer Center between February 2015 to March 2023. MRI was performed every two months, while HRQoL was assessed monthly using the EQ-5D-5L. This tool evaluates five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each on a 5-level scale. A standardized scoring algorithm was used to derive a single QoL index. Changes in HRQoL scores were compared to radiographic progression using the Wilcoxon test, including subscale analyses. RESULTS The follow-up period ranged from 3 to 25 months (median: 6 months), with a mean progression-free survival of 7.2 months. HRQoL scores declined significantly at the time of radiographic progression (P <.0001) and approximately one month prior (P =.046). Subscale analyses revealed significant declines in all five domains at progression, with “mobility” and “self-care” showing significant decreases one month before radiographic progression. DISCUSSION/CONCLUSIONS Declines in HRQoL, particularly in mobility and self-care, preceded radiographic evidence of tumor progression in malignant glioma patients receiving bevacizumab. These findings suggest that regular HRQoL monitoring may serve as a non-invasive, patient-centered adjunct to MRI, potentially enabling earlier detection of disease worsening and improving clinical decision-making.