Top

28-06-2016 | CNS metastases | Article

Symptoms and quality of life in patients with brain metastases receiving whole-brain radiation therapy

Journal: Supportive Care in Cancer

Authors: Erin Wong, Liying Zhang, Leigha Rowbottom, Nicholas Chiu, Leonard Chiu, Rachel McDonald, May Tsao, Elizabeth Barnes, Cyril Danjoux, Edward Chow

Publisher: Springer Berlin Heidelberg

Abstract

Purpose

Patients with multiple brain metastases may be treated with whole-brain radiation therapy (WBRT). For these patients, symptom palliation and improvement of quality of life (QOL) and performance status is of the upmost importance. The objective of the present study was to determine the symptom experience and overall QOL in patients with brain metastases before and after WBRT.

Methods

A total of 14 symptom scores and overall QOL were collected prospectively in 217 patients for up to 3 months. Wilcoxon signed rank test was applied to determine significant symptoms and QOL changes. Spearman’s correlations were applied to determine the relationship between symptom scores and QOL.

Results

Appetite loss, weakness, and nausea significantly increased from baseline, while balance, headache, and anxiety significantly decreased from baseline. At baseline, all symptoms other than coordination were significantly correlated with QOL. At 1-month follow-up (FU), changes in concentration, weakness, coordination, and balance were significantly associated with QOL changes. At 2-month FU, changes in pain, insomnia, concentration, balance, and depression were significantly associated with QOL changes. At 3-month FU, only change in nausea was significantly associated with QOL changes.

Conclusions

Following WBRT, certain symptoms may influence overall QOL to a greater extent than others, which may fluctuate with time.

Gavrilovic IT, Posner JB (2005) Brain metastases: epidemiology and pathophysiology. J Neuro-Oncol 75(1):5–14CrossRef

Thomas SS, Dunbar EM (2010) Modern multidisciplinary management of brain metastases. Curr Oncol Rep 12(1):34–40CrossRefPubMed

Gori S, Rimondini S, De Angelis V, Colozza M, Bisagni G, Moretti G, et al. (2007) Central nervous system metastases in HER-2 positive metastatic breast cancer patients treated with trastuzumab: incidence, survival, and risk factors. Oncologist 12(7):766–773CrossRefPubMed

Bezjak A, Adam J, Barton R, Panzarella T, Laperriere N, Wong CS, et al. (2002) Symptom response after palliative radiotherapy for patients with brain metastases. Eur J Cancer 38(4):487–496CrossRefPubMed

Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Gaspar LE, et al. (2012) Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol 2(3):210–225CrossRefPubMedPubMedCentral

Pulenzas N, Khan L, Tsao M, Zhang L, Lechner B, Thavarajah N, et al. (2014) Fatigue scores in patients with brain metastases receiving whole brain radiotherapy. Support Care Cancer 22(7):1757–1763CrossRefPubMed

Tsao MN, Lloyd N, Wong RK, Chow E, Rakovitch E, Laperriere N, et al. (2012) Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev 4:CD003869PubMed

Patchell RA (2003) The management of brain metastases. Cancer Treat Rev 29(6):533–540CrossRefPubMed

Popovic M, Nguyen J, Chen E, Di Giovanni J, Zeng L, Chow E (2012) Comparison of the EORTC QLQ-BM22 and the FACT-BP for assessment of quality of life in cancer patients with bone metastases. Expert Rev Pharmacoecon Outcomes Res 12(2):213–219CrossRefPubMed

10.

Caissie A, Nguyen CE, Zhang L, Saghal A, Clemons M, et al. (2012) Quality of life in patients with brain metastases using the EORTC QLQ-BN20 + 2 and QLQ-C15-PAL. Int J Radiat Oncol Biol Phys 83(4):1238–1245CrossRefPubMed

11.

Chiu L, Chiu N, Zeng L, Zhang L, Popovic M, Chow R, et al. (2012) Quality of life in patients with primary and metastatic brain cancer as reported in the literature using the EORTC QLQ-BN20 and QLQ-C30. Expert Rev Pharmacoecon Outcomes Res 12(6):831–837CrossRefPubMed

12.

Hall WA, Djalilian HR, Nussbaum ES, Cho KH (2000) Long-term survival with metastatic cancer to the brain. Med Oncol 17(4):279–286CrossRefPubMed

13.

Wong J, Hird A, Kirouâ E, Mauro A, Napolskikh J, Chow E (2008) Quality of life in brain metastases radiation trials: a literature review. Curr Oncol 15(5):25–45CrossRefPubMedPubMedCentral

14.

Chow E, Davis L, Holden L, Tsao M, Danjoux C (2005) Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases. J Pain Symptom Manag 30(1):18–23CrossRef

15.

Yaneva MP, Semerdjieva MA (2006) Assessment of the effect of palliative radiotherapy for cancer patients with intracranial metastases using EORTC-QOL-C30 questionnaire. Folia Med (Plovdiv) 48(2):23–29

16.

Gerrard GE, Prestwich RJ, Edwards A, Russon LJ, Richards F, Johnston CF, et al. (2003) Investigating the palliative efficacy of whole-brain radiotherapy for patients with multiple-brain metastases and poor prognostic features. Clin Oncol (R Coll Radiol) 15(7):422–428CrossRef

17.

Addeo R, Caraglia M, Faiola V, Capasso E, Vincenzi B, Montella L, et al. (2007) Concomitant treatment of brain metastasis with whole brain radiotherapy and temozolomide is active and improves quality of life. BMC Cancer 7:18CrossRefPubMedPubMedCentral

18.

Scott C, Suh J, Stea B, Nabid A, Hackman J (2007) Improved survival, quality of life, and quality-adjusted survival in breast cancer patients treated with efaproxiral (Efaproxyn) plus whole-brain radiation therapy for brain metastases. Am J Clin Oncol 30(6):580–587CrossRefPubMed