How Radiation Oncologists Evaluate and Incorporate Life Expectancy Estimates Into the Palliative Treatment of Cancer Patients: A Survey-Based Study

Abstract

Purpose/Objective(s): Fatigue is frequently experienced in patients with brain metastases (BM) and can impair quality of life (QOL). The purpose of this study is to examine the change in fatigue scores over time in patients receiving whole brain radiation therapy (WBRT) with different assessment tools. Materials/Methods: QOL scores were prospectively collected in patients with BM treated with WBRT. Items relating to fatigue in the Edmonton Symptom Assessment System (ESAS), Brain Symptom and Impact Questionnaire (BASIQ), Spitzer Questionnaire, European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), EORTC brain module (EORTC QLQ-BN20+2), EORTC QLQ-C15-PAL, and Functional Assessment of Cancer Therapy General (FACT-G) were included this study. Questionnaires were organized and analyzed based on scales used: 0-10, 1-4, and 0-4 at baseline, 1, 2 and 3 months follow-up. The Wilcoxon Signed Rank test was used to determine whether fatigue scores changed over time compared to baseline prior to WBRT. Results: Three hundred seventy-one patients with follow-up data were available for analysis. Three hundred nine patients completed at least one follow-up using a questionnaire with a scale of 1-4 (Spitzer, PAL15, BN20+2, QLQ-C30) and 0-4 (FACT-G). The median KPS was 80 and median age was 64 years. There was significant fatigue score increases at months 1 and 2 compared to baseline fatigue score (p < 0.0001, p Z 0.0008), respectively. No significant increase (p Z 0.13) was detected at month 3. There was an increase in fatigue score in patients without dexamethasone (Dx) at month 1 (p Z 0.015) but no differences were observed in subsequent follow-ups. Sixty-two patients completed at least one follow-up using a questionnaire with a scale of 0-10 (ESAS, BASIQ). The median KPS was 70 and median age was 64 years. There was fatigue score increases at month 1 compared to baseline (p Z 0.009). Other two months had no significant changes. There was no difference on fatigue changes between patients with and without Dx treatment (p Z 0.2). Conclusions: There was an increase in fatigue in the first two months following WBRT, but no difference in fatigue scores between patients treated with and without Dx in majority of patients. Fatigue is an important symptom outcome that needs to be addressed in patients treated with WBRT. Author Disclosure: L. Khan: None. M. Tsao: None. N. Pulenzas: None. L. Zhang: None. N. Thavarajah: None. B. Lechner: None. E. Barnes: None. C. Danjoux: None. E. Chow: None.