Medicine (St Vincent's) - Theses
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ItemClinical, molecular and psychosocial profiling of long-term survivors of glioblastoma( 2020)Glioblastoma is the most common and most aggressive primary brain tumor in adults. It affects approximately 5.5 per 100,000 people in Australia, with incidence increasing by 3% per year. It is the sixth leading cause of cancer burden in Australia and is associated with significant morbidity from diagnosis. Prior to 2005, the mainstay of treatment was maximal surgical resection followed by radiotherapy with three- and five-year survival rates of 4.4% and 1.9% respectively. In 2005, the addition of concurrent oral temozolomide chemotherapy to standard radiotherapy demonstrated a modest improvement in overall survival with three- and five-year survival rates of 16% and 9.8% respectively. This established combined therapy as standard treatment for this condition (Stupp protocol) and highlighted the prospect of longer term survival as a small but distinct possibility. Long-term survivors of glioblastoma have been defined as patients alive 18 months to 5 years following diagnosis, without clear consensus on an appropriate definition. Approximately 13.7% of all patients diagnosed with glioblastoma survive longer than 2 years. With improved surgical and radiotherapy techniques, and the introduction of new therapies such as targeted therapy, the numbers in this group may continue to grow. Predicting who these patients are and understanding the nature and experience of their survivorship becomes paramount. The purpose of this thesis is to gain a comprehensive understanding of long-term survivors of glioblastoma, defined as patients diagnosed with glioblastoma who survive at least two years. Using a mixed methods approach, it combines elements of quantitative research, such as chart reviews, quality of life questionnaires and neurocognitive assessment, with qualitative research, such as semi-structured interviews. Together, this thesis addresses three major facets. Firstly, to be able to recognise at diagnosis patients that are likely to survive longer. Secondly, to develop a detailed understanding of the lived experience and patient reported concerns faced by long-term survivors of glioblastoma. Thirdly, to increase the proportion of long-term survivors through targeted clinical trials. Ultimately, this thesis provides insight into the care needs of patients, facilitates the planning of treatment and supportive care by clinicians, identifies options for improving access to clinical trials and recognises the support networks required for both patients and their caregivers to uphold their quality of life.