title: Relationship between neurocognitive function and quality of life after whole-brain radiotherapy in patients with brain metastasis.
abstract: OBJECTIVE
  To examine the relationship between neurocognitive function (NCF) and quality of life (QOL) in patients with brain metastases after whole-brain radiotherapy.
  
  
  METHODS
  A total of 208 patients from the whole-brain radiotherapy arm of a Phase III trial (PCI-P120-9801), who underwent regular NCF and QOL (ADL [activities of daily living] and FACT-Br [Functional Assessment of Cancer Therapy-Brain-specific]) testing, were analyzed. Spearman's rank correlation was calculated between NCF and QOL, using each patient's own data, at each time point. To test the hypothesis that NCF declines before QOL changes, the predictive effect of NCF from previous visits on QOL was studied with a linear mixed-effects model. Neurocognitive function or QOL deterioration was defined relative to each patient's own baseline. Lead or lag time, defined as NCF deterioration before or after the date of QOL decline, respectively, was computed.
  
  
  RESULTS
  At baseline, all NCF tests showed statistically significant correlations with ADL, which became stronger at 4 months. A similar observation was made with FACT-Br. Neurocognitive function scores from previous visits predicted ADL (p < 0.05 for seven of eight tests) or FACT-Br. Scores on all eight NCF tests deteriorated before ADL decline (net lead time 9-153 days); and scores on six of eight NCF tests deteriorated before FACT-Br (net lead time 9-82 days).
  
  
  CONCLUSIONS
  Neurocognitive function and QOL are correlated. Neurocognitive function scores from previous visits are predictive of QOL. Neurocognitive function deterioration precedes QOL decline. The sequential association between NCF and QOL decline suggests that delaying NCF deterioration is a worthwhile treatment goal in brain metastases patients.
authors.affiliation: Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, WI 53792, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Soren M
authors.initials: SM
authors.lastname: Bentzen
authors.forename: Jialiang
authors.initials: J
authors.lastname: Li
authors.forename: Markus
authors.initials: M
authors.lastname: Renschler
authors.forename: Minesh P
authors.initials: MP
authors.lastname: Mehta
mesh_terms: D000203:Activities of Daily Living; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy / Q000556:secondary; D003071:Cognition / Q000528:radiation effects*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D016371:Cranial Irradiation / Q000009:adverse effects*; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000473:pathology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life; D013997:Time Factors