Prospective assessment of quality of life following whole brain radiotherapy for brain metastases

Abstract

To prospectively assess quality of life in patients with brain metastases treated with whole brain radiotherapy. Patients with brain metastases treated with whole brain radiotherapy were asked to rate their own symptoms employing Edmonton Symptom Assessment Scale (ESAS) before, 1, 2, 4, 8 and 12 weeks following the radiation treatment. ESAS evaluates pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well being and shortness of breath on a scale of 0–10 (0 = absence of symptoms and 10 = worst possible symptom). Patients with language barrier and poor mental status were excluded. The mean difference of ESAS symptoms at each follow up were compared with baseline and p < 0.01 was considered statistically significant. One hundred and seventy patients (102 female and 68 male) were included between January 1999 to January 2002. Their median age was 66 years (range 33–84) and their median Karnofsky performance score at baseline was 60 (range 20–90). The most common primary cancer sites were lung 99 (58%), breast 32 (19%), gastrointestinal 16 (9%), unknown 14 (8%) and others 9 (6%). One third had significant weight loss (more than 10% over the last 6 months). All patients were prescribed dexamethasone of varying doses during radiotherapy. The dose fractionations were 20 Gy in 5 fractions, 138 (81%); 30 Gy in 10 fractions 7 (4%) and others 25 (15%). The baseline mean and SD for ESAS scores were: pain 2.4 and 2.8, fatigue 5.3 and 2.8, nausea 1.3 and 2.2, depression 2.8 and 2.7, anxiety 3.6 and 3.0, drowsiness 3.5 and 2.9, appetite 3.0 and 3.2, sense of well being 3.8 and 2.7 and shortness of breath 2.3 and 2.5. The statistically significant mean difference from baseline were: Week 1: fatigue 1.4, drowsiness 1.5; Week 2: fatigue 1.2, drowsiness 1.3; Week 4 drowsiness 1.5; Week 8: drowsiness 2.0, appetite 3.4, sense of well being 1.9; Week 12: pain 2.0, fatigue 2.1, drowsiness 2.9, appetite 3.4, sense of well being 2.1 and shortness of breath 1.8. Thirty-two (19%) and 34 (20%) patients died within the first and second month following radiotherapy respectively. Certain parameters of quality of life such as fatigue and drowsiness worsened after the whole brain radiotherapy