QOL-26DESCRIBING SYMPTOM BURDEN IN PATIENTS WITH LEPTOMENINGEAL METASTASES: SELECTING AN INSTRUMENT

Abstract

BACKGROUND: Patients with leptomeningeal metastases (LM) have disease burden involving the membranes surrounding the brain, spinal cord or both, and a short disease trajectory. Limited studies have explored presenting symptoms and the relationship to functional status. The objectives of this study are to evaluate the utility of the MD Anderson Symptom Inventory-brain tumor (MDASI-BT) and the MDASI-spine tumor (MDASI-SP) symptom report instruments in capturing presenting symptoms in this population, and to describe functional status (Karnofsky Performance Score [KPS]) in relation to endorsed symptoms and tumor location. METHODS: Clinical records of 45 patients with LM were reviewed for presenting symptoms. Endorsed symptoms were recorded using the MDASI-BT and MDASI-SP. Both instruments were modified to capture dichotomous data (present/not present). Additional demographic and clinical data were collected (age, gender, tumor location, and KPS). Frequency analysis was used to describe symptom occurrence and KPS. Two-way analysis of variance (ANOVA) was performed to explore differences in KPS for tumor location, and endorsed symptoms. RESULTS: The subjects were primarily female (80%), with a median age of 51 years. The most common location of LM was the brain (42.2%) followed by both brain and spine involvement (37.8%). Twenty-one (46.7%) endorsed symptoms corresponding to both the MDASI-BT and the MDASI-SP. Of those endorsing symptoms corresponding with only one instrument, a greater number of patients reported symptoms corresponding with the MDASI-BT (31%). Pain was the most frequently reported presenting symptom (33%), followed by numbness/tingling (31%). KPS at diagnosis ranged from 50% to 100% (median = 80%). Using ANOVA there was no significant difference in KPS for tumor location and endorsed symptoms. CONCLUSIONS: These findings indicate that, based on frequency analysis, the MDASI-BT shows slightly greater utility in capturing symptoms in LM patients at presentation. KPS was not associated with endorsed symptoms or tumor location at presentation of LM.