The neurocognitive function change criteria after whole-brain radiation therapy for brain metastasis, in reference to health-related quality of life changes: a prospective observation study

Abstract

Background: We sought to construct the optimal neurocognitive function (NCF) change criteria sensitive to healthrelated quality of life (HR-QOL) in patients who have undergone whole-brain radiation therapy (WBRT) for brain metastasis. Methods: We categorized the patients by the changes of NCF into groups of improvement versus deterioration if at least one domain showed changes that exceeded the cutoff while other domains remained stable. The remaining patients were categorized as stable, and the patients who showed both significant improvement and deterioration were categorized as 'both.' We examined the clinical meaning of NCF changes using the cutoff values 1.0, 1.5, and 2.0 SD based on the percentage of patients whose HR-QOL changes were ≥ 10 points. Results: Baseline, 4-month and 8-month data were available in 78, 41 (compliance; 85%), and 29 (81%) patients, respectively. At 4 months, improvement/stable/deterioration/both was seen in 15%/12%/41%/32% of the patients when 1.0 SD was used; 19%/22%/37%/22% with 1.5 SD, and 17%/37%/37%/9% with 2.0 SD. The HR-QOL scores on the QLQ-C30 functional scale were significantly worse in the deterioration group versus the others with 1.0 SD (p = 0.013) and 1.5 SD (p = 0.015). With 1.5 SD, the HR-QOL scores on the QLQ-BN20 was significantly better in the improvement group versus the others (p = 0.033). However, when 'both' was included in 'improvement' or 'deterioration,' no significant difference in HR-QOL was detected. Conclusions: The NCF cutoff of 1.5 SD and the exclusion of 'both' patients from the 'deterioration' and 'improvement' groups best reflects HR-QOL changes.

Treatment Patterns and Outcomes of Women with Symptomatic and Asymptomatic Breast Cancer Brain Metastases: A Single-Center Retrospective Study

“…The decision regarding which treatments to offer can be challenging and often depends on clinical factors such as the number and size of BrM, presence of neurologic symptoms, patient performance status, and degree of extracranial disease control [13–21]. Unfortunately, patients with BrM perform poorly on quality of life indicators owing to neurologic symptoms secondary to their intracranial metastatic disease and treatment‐related toxicity [22–32]. As the incidence of BrM among women living with MBC continues to increase over time, likely due to improvements in early detection and systemic disease control, there is an increasing need for the implementation of evidence‐based interventions that prolong survival with minimal side effects and, in particular, preservation of neurocognitive function.…”

Longitudinal trajectory of quality of life for patients with melanoma brain metastases: A secondary analysis from a whole brain radiotherapy randomized clinical trial

“…Older age (≥65 years) emerged as the most consistent predictor of poorer QoL outcomes, with significant associations with decreased physical, role, social and cognitive functioning and global health status, and increased motor dysfunction and future uncertainty. Older age was associated with QoL in some studies [23] , [24] but not others [25] , [26] , [27] . With increasing age, especially when patients are diagnosed with medical conditions, their ability to compensate for physical and cognitive difficulties decreases [28] , [29] , which may have a detrimental impact on QoL.…”