Quality-of-life trajectories after stereotactic radiosurgery for brain metastases

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Quality of life (QOL) is an important endpoint measure of cancer treatment. The authors’ goal was to evaluate QOL trajectories and prognostic value in cancer patients treated with stereotactic radiosurgery (SRS) for brain metastases.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Patients who underwent Gamma Knife radiosurgery (GKRS) between January 2016 and November 2019 were prospectively evaluated for QOL using the EQ-5D-3L questionnaire before SRS and at follow-up visits. Only patients who had pre-SRS and at least 1 post-SRS QOL assessment were considered.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Fifty-four cancer patients underwent 109 GKRS procedures. The first post-SRS visit was at a median of 2.59 months (range 0.13–21.08 months), and the last post-SRS visit was at 14.72 months (range 2.52–45.21 months) after SRS. There was no statistically significant change in the EQ-5D index score (p = 0.539) at the first compared with last post-SRS visit. The proportion of patients reporting some problems on the EQ-5D dimension of self-care increased during the course of follow-up from 9% (pre-SRS visit) to 18% (last post-SRS visit; p = 0.03). The proportion of patients reporting problems on the EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression remained stable during the course of follow-up (p ≥ 0.106). After adjusting for clinical variables, a higher recursive partitioning analysis (RPA) class (i.e., worse prognostic category) was independently associated with greater odds for EQ-5D index score deterioration (p = 0.050). Upfront whole-brain radiation therapy predicted deterioration of the EQ-5D self-care (p = 0.03) and usual activities (p = 0.024) dimensions, while a greater number of lesions predicted deterioration of the EQ-5D anxiety/depression dimension (p = 0.008). A lower pre-SRS EQ-5D index was associated with shorter survival independently from clinical and demographic variables (OR 18.956, 95% CI 2.793–128.64; p = 0.003).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>QOL is largely preserved in brain metastasis patients treated with SRS. Higher RPA class, upfront whole-brain radiation therapy, and greater intracranial disease burden are independent predictors of post-SRS QOL deterioration. Worse pre-SRS QOL predicts shorter survival. Assessment of QOL is recommended in brain metastasis patients managed with SRS.</jats:p></jats:sec>

Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis

“…Our study results should be interpreted with caution given heterogeneity of studies included in the meta-analysis in patient populations and mHealth interventions. Nevertheless, our findings support that mHealth interventions can help improve the HRQoL of cancer patients or prevent it from deteriorating, a phenomenon that is often inevitable given the progressive course of the disease ( Basch et al, 2016 ; Bunevicius et al, 2020 ; Giesinger et al, 2011 ).…”

A Dutch phase III randomized multicenter trial: whole brain radiotherapy versus stereotactic radiotherapy for 4–10 brain metastases

“… 16 A very recent study confirmed that QOL is preserved in patients treated with SRS, in which upfront WBRT is an independent predictor of QOL deterioration. 17 The results of this study showed a decline in the EQ5D of 0.1 in the SRS group versus 0.2 in the WBRT group, which meets our expectations and shows that QOL is preserved at least as good in the SRS group as in the WBRT group. More mature results of randomized trials are needed to definitely confirm our hypothesis.…”

Quality of life among patients with 4 to 10 brain metastases after treatment with whole-brain radiotherapy vs. stereotactic radiotherapy: a phase III, randomized, Dutch multicenter trial

“…Multiple studies have shown that QoL is preserved or even, likely, improved among patients treated with SRT. Additionally, upfront WBRT independently predicts QoL deterioration, and increased BM numbers were associated with worsening in the overall EQ5D (7,28). More mature randomized-trial results are needed to confirm our hypothesis.…”