# Prospective inter‐individual analysis of quality‐adjusted life years (QALYs) in brain tumor patients: A comprehensive assessment of health preferences

## TL;DR

This study tracks how brain tumor patients perceive their quality of life before and after surgery, showing initial declines followed by recovery and adaptation.

## Contribution

This is the first study to quantify health preferences in patients with eloquent brain tumors using Time Trade-Off and Standard Gamble methods.

## Key findings

- Preoperative quality of life was high (TTO median 0.9), but EQ-5D scores declined significantly after surgery.
- By 6 months post-surgery, health perceptions improved, indicating resilience and adaptation.
- Dependency was rated as less severe at 3 months compared to preoperative assessments.

## Abstract

Eloquent intracranial tumors, whether primary or secondary, are located in brain regions critical for language, motor, or sensory function. In neuro‐oncology, evaluating treatment outcomes requires more than survival analysis alone. Quality‐adjusted life years combine survival and quality of life, based on numerical health preference values reflecting how patients perceive specific health states. However, such data are lacking for patients with eloquent tumors. In this prospective, single‐center cohort study (2016–2019), patients with eloquent brain tumors underwent standardized assessments at four time points: preoperative, postoperative, and at 3‐ and 6‐month follow‐ups. Instruments included Time Trade‐Off (TTO), Standard Gamble, EuroQol 5 Dimensions (EQ‐5D), and the Beck Depression Inventory (BDI). Patients indicated how many years from a 10‐year life span they would trade to live in perfect health, including for hypothetical deficits like hemiparesis, aphasia, or dependency. The resulting values (range 0–1) were calculated and analyzed using Mann–Whitney U‐tests. Preoperatively, 78 patients reported high quality of life (TTO median 0.9). EQ‐5D index declined significantly after surgery (p < .05), while TTO and BDI scores remained stable, reflecting a deterioration in health. At 3 months (n = 23), dependency was rated as less severe compared to preoperative (p = .055; TTO 0.2 vs. 0.5), suggesting psychological adaptation. By 6 months (n = 8), health perceptions improved, indicating resilience (TTO 0.7 vs. 0.6 at 3 months). This is the first study to quantify health preferences in patients with eloquent brain tumors. While postoperative health status initially declines, resilience and adaptation occur over time, emphasizing the need for tailored postoperative care.

Eloquent intracranial tumors present unique challenges in neurosurgical treatment due to their proximity to critical functional areas of the brain. This prospective, single‐center cohort study quantified real‐time changes in patients' subjective burden of health impairments using the Time Trade‐Off and Standard Gamble methods, providing disease‐specific data for quality‐adjusted life year calculations. The findings highlight the relevance of functional burden over tumor type and support more patient‐centered, health‐economic decision‐making in neuro‐oncology. While postoperative health status initially declined, resilience and adaptation occurred over time. These insights underscore the importance of integrating psychological adaptation and long‐term quality of life into clinical evaluations.