Qlif-46. The Experience of Medical Care-Related Decisions Among Malignant Brain Tumor Patients in Japan: Qualitative Interviews

Abstract

BACKGROUND: Patients with leptomeningeal metastasis (LM) have symptoms related to disease within the neuroaxis, cancer sites outside the neuroaxis and treatment toxicities. The meaning ascribed to advanced cancer has been shown to impact the perceived severity of symptoms as well as quality of life (QoL) and depression. Our aim was to explore and describe relationships among meaning of illness (MoI), depression, QoL and symptom burden in LM patients and to explore whether adding spine-related items from the MD Anderson Symptom Inventory-Spine (MDASI-SP) to the MDASI-Brain Tumor (BT) enhanced understanding of symptom burden in LM patients. METHODS: Thirty participants with LM were consented and enrolled into one of two groups: Newly-diagnosed (n=15) and on active treatment (n=15). Five items unique to the MDASI-SP were added to the MDASI-BT and the difference between the mean scores of the MDASI-BT and modified MDASI-BT was analyzed. The relationships among variables were assessed with correlational analysis. RESULTS: The sample was primarily white (73%), female (63%) with a median age of 54 years. Breast cancer was the most common primary cancer (50%) with the brain being the most common site of metastasis (23%). There were no associations between MoI and symptom burden (p=.12). Higher MoI was associated with better QoL (p<.01) and less depression (p<.01). Though there was no significant difference between the original and modified MDASI-BT (p=.33), there was a wide range of responses to the spine related items with some considered to be severe. CONCLUSION: Depressive symptoms and QoL in LM patients were related to better MoI indicating a need for further exploration. The wide range of responses to spine-related items on the modified MDASI-BT indicate the need for an instrument to measure symptoms anywhere along the neuroaxis. Longitudinal studies exploring the relationship of MoI with symptom burden may clarify non-significant associations.