Abstract
Introduction:
Historically, outcome measures of neurosurgical or radiotherapeutic intervention for brain metastases have focused on overall or progression free survival, but understanding patient-reported outcomes and health-related quality of life has become increasingly important. Rates of brain metastases have risen due to lengthened life expectancies in patients with systemic cancer and better detection with improved imaging modalities. Brain metastases are reported in 20-40% of patients with systemic cancers and are associated with reduced quality of life and shortened life expectancy. A variety of patient-reported outcome measures (PROMs) have been employed to assess the effect of therapy on quality of life in this population. Here, we review all PROMs relevant to patients with brain metastases.
Methods:
A systematic review of the literature was conducted in accordance with the PRISMA guidelines using PubMed, Embase, and Cochrane databases. Selected studies reported outcomes on brain metastasis patients treated with neurosurgical intervention, whole brain radiation therapy, or stereotactic radiotherapy. Patient-reported data on health related quality of life were extracted from the studies that met the inclusion criteria. A meta-analysis was not performed due to the heterogeneity in health-related quality of life metrics.
Results:
From our search we identified 2526 articles. We included 177 full text articles after the initial screening. The methods and instruments used to assess health-related quality of life in patients treated for brain metastases were heterogeneous. In addition to the physical effects of the disease itself, the psychological implications of the diagnosis and the neurologic effects of treatment were major contributors to the reduced quality of life in these patients.
Conclusion:
There is a lack of PROMs specific for brain metastasis patients, yet an understanding of quality of life outcomes in these patients can be useful to clinicians in informing goal-directed care discussions. Therefore, future research on neurosurgical or radiotherapeutic interventions for brain metastasis should focus not only on survival-ship but also on indicators of life quality and patient-reported outcomes. Clinicians should continue to incorporate quality of life outcomes in their discussion with patients about therapeutic options for brain metastases.