Health-related quality of life of patients with brain metastases selected for stereotactic radiosurgery

Eline Verhaak,Karin Gehring,Patrick E J Hanssens,Margriet M Sitskoorn

doi:10.1007/s11060-019-03186-z

Abstract

PurposeInformation on health-related quality of life (HRQoL) of patients with brain metastases (BM) before stereotactic radiosurgery (SRS) is very relevant to improve communication between patients and clinicians and to be able to interpret changes in HRQoL after SRS. The aim of this study was to evaluate the prevalence and severity of complaints on different aspects of pre-SRS HRQoL among patients with BM and to identify predictors thereof.MethodsPatients with 1–10 newly diagnosed BM, expected survival > 3 months, Karnofsky Performance Status ≥ 70, and scheduled to undergo SRS were included. HRQoL was measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) questionnaire. One-sample z-tests were conducted to analyze differences between patients with BM and published normative data of a general adult sample and of an adult cancer sample. Multiple regression analyses were run to identify predictors of pre-SRS HRQoL.ResultsOn the individual level, most patients with BM (57.6% of 92 included patients) reported complaints regarding emotional well-being. As a group, patients with BM reported significantly lower emotional well-being compared to both control groups and significantly higher social well-being compared to the general population. Worse psychological factors, e.g. physical fatigue, depression, mental fatigue and anxiety, predicted aspects of pre-SRS HRQoL.ConclusionsAn increased understanding of pre-SRS HRQoL and predictors hereof, provides us with more insight into the well-being of our patients with BM and is necessary for the interpretation of (changes in) HRQoL after SRS.

Highlights

Often, patients with brain metastases (BM) experience several symptoms prior to treatment of the BM, such as headaches, seizures, focal neurological deficits and cognitiveElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Habets et al [8] were the first to compare health-related quality of life (HRQoL) of patients with BM selected for stereotactic radiosurgery (SRS) to the general population
Both studies indicate that the majority of patients already experience problems with HRQoL pre-SRS
Our patients with BM reported statistically significant and clinically meaningful lower emotional well-being than the general population and adult cancer sample

Summary

Introduction

Habets et al [8] were the first to compare HRQoL of patients with BM selected for SRS to the general population. The pre-SRS HRQoL subscale scores of the 97 patients were significantly worse compared to the general population [8]. In a subsequent study, evaluating HRQoL in 55 patients with BM pre-SRS, 89% of the patients had a significantly worse score on at least 1 of the 6 HRQoL scales compared to the general population, with physical functioning (57%) most often affected [9]. Higher KPS pre-SRS has been associated with better pre-SRS HRQoL [8] and post-SRS HRQoL [10, 11]. Pre-SRS asymptomatic BM, low recursive partitioning analysis (RPA) class, no seizures and no selfreported cognitive impairment were associated with higher HRQoL following SRS [11]

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