Sex-based Differences in Quality of Life for Sporadic Vestibular Schwannoma Patients Managed With Observation, Microsurgery, or Radiation

OBJECTIVE: Quality of life (QOL) is an important consideration in vestibular schwannoma (VS) patients when assessing management options. Understanding sex-based differences in QOL may facilitate patient counseling. STUDY DESIGN: Prospective cohort. SETTING: Tertiary academic medical center and Acoustic Neuroma Association. PATIENTS: Sporadic VS patients. INTERVENTIONS: Observation, microsurgery, or radiation. MAIN OUTCOME MEASURES: Penn Acoustic Neuroma Quality of Life (PANQOL) scores. RESULTS: A total of 481 patients were analyzed. In the observation group, women reported worse anxiety, facial function, and total PANQOL scores at baseline. At follow-up, men declined more in facial function (-5 vs. +3, P=0.01). For microsurgery, women reported worse facial function and balance scores at baseline. At follow-up, men declined more in facial function (-16 vs. -3, P<0.001), balance (-7 vs. +2, P=0.04), energy (-4 vs. +5, P=0.03), and total (-5 vs. +2, P=0.02) PANQOL scores. For radiation, women reported worse anxiety, balance, pain, and total scores at baseline. At follow-up, anxiety improved in women but worsened in men (+5 vs. -6, P=0.008). Sex-based differences exceeding the minimally important difference thresholds established for the PANQOL were observed for the following: anxiety at baseline in the observation group, anxiety and pain at baseline in the radiation group, and change in anxiety from baseline to follow-up in the radiation group. CONCLUSIONS: Women had worse anxiety, balance, facial function, pain, and overall QOL at baseline assessed using the PANQOL, whereas men declined more with treatment and observation. The largest difference in PANQOL change between sexes occurred after microsurgery, with men experiencing greater losses in facial function, balance, energy, and total scores.