OS02.5.A ASSESSING QUALITY OF LIFE IN BRAIN METASTASES PATIENTS AND THEIR CAREGIVERS UNDERGOING RADIOTHERAPY: A COMPARATIVE ANALYSIS WITH HEALTHY AND CANCER POPULATIONS
Authors: Cialdella F , van Grinsven E E , Nagtegaal S , David S , Philippens M , Verhoeff J J C 
Published: October 2024

Abstract

BACKGROUND
Brain metastases (BM) are diagnosed in 10-30% of all cancer patients, and the incidence is expected to rise due to advancements in primary tumor management. Besides survival, the impact of treatment on quality of life (QoL) and course of disease is highly relevant for patients and their caregivers. The aim of this (sub)study was to collect patient-reported outcomes (PROs) from patients with BM and their caregivers and to assess the impact of BM on their QoL.

MATERIAL AND METHODS
In the Cohort for patient-reported Outcomes, Imaging and trial inclusion in Metastatic BRAin disease (COIMBRA) (ClinicalTrials.gov Identifier: NCT05267158), PROs were prospectively collected via questionnaires pre-radiotherapy (RT), 1 month post-RT, and every 3 months thereafter. Collected PROs included the EORTC QLQ-C30, BN20, Cognitive Failures Questionnaire (CFQ), Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Inventory (MFI), and the caregiver strain index (CSI) for caregivers.

RESULTS
From April 2019 to April 2023, 377 patients were included, the majority with lung cancer (51.7%) and an equal sex distribution. The median was age 66 years (IQR 58 - 72). 72.9% (N=276) patients and 115 caregivers (83.3%) consented to PRO completion, with a response rate pre-RT of 78.5% and 77.4% respectively. Comparison of EQ5D-VAS with reference values indicates that performance scores are lower in patient with BM than in the general population. COIMBRA cohort scores (median: 70) are comparable to cancer patients (median: 68) and lower than the median of 82 in the healthy population. Additionally, in the HADS fewer patients report signs of anxiety or depression pre-RT compared to the cancer population (20.2% vs 26% for anxiety, and 24% vs 28.2% for depression). Moreover, pre-RT, 30.1% of caregivers indicated feeling overloaded (CSI score ≥ 7). In the HADS, 30.9% of caregivers reported signs of anxiety and 33.3% signs of depression.

CONCLUSION
QoL is an important consideration in the treatment of BM, next to survival. Traditionally, the QoL aspects of the caregivers have been overlooked in a research setting. The COIMBRA cohort shows that, despite the challenges of BM, patients’ experienced QoL and symptom burden are remarkably parallel to those of other cancer patients. Caregivers experience a significant burden with a large proportion reporting anxiety, depression, and feelings of overload. This study represents one of the first efforts to comprehensively assess the caregiver experience of patients with BM using validated scales, emphasizing the importance of considering caregiver well-being in the management of patients with BM. These findings emphasize the urgent need for integrated care strategies that address both the physical and psychological aspects of BM, proactively supporting mental health and overall well-being, and taking into account the QoL of the caregivers too.