Work resumption following lower-grade glioma surgery: a multicenter cohort study

Abstract Background Patients with lower-grade glioma (LGG) are often of working age. For LGG patients post-surgical work resumption is at risk from treatment including resective surgery. However, little is known on determinants of returning to work. In this study we examined determinants of post-surgical work resumption after nine months using patient- and tumor-related characteristics, such as tumor and resection cavity locations. Material and Methods This retrospective multicenter cohort study included adults with supratentorial WHO grade II and III gliomas who underwent a first-time surgery in Paris, Munich or Amsterdam between 2011 and 2016. Patient-related characteristics included age, sex, patient condition, received treatments, classification of work type and skill level. Presurgical tumors and postsurgical resection cavities were manually segmented on MRI and registered to standard brain space. These segmentations were mapped to Schaefer, XTRACT and Harvard-Oxford atlas parcellations of cortical, white matter and grey nuclei structures. Predictors of postsurgical return to work were examined in multivariable logistic regression and Bayesian hurdle regression models. Results The cohort consisted of 219 patients. Before surgery 192 (88%) patients were able to work, and after surgery 119 (62%) resumed work. Independent predictors of returning to work were male sex (OR = 3.21, CI = 1.44 - 7.46, p = 0.005) and lower age (per 1 year older, OR = 0.96, CI = 0.92 - 0.99, p = 0.029). No associations were found between work resumption and locations of the tumor or resection cavity. Conclusion Many patients are able to work before and many return to work after first-time LGG surgery. Inability to resume work is exclusively associated with patient-related characteristics and not with tumor or resection locations. This novel information may inform patient counseling.