title: FACT-Br for assessment of quality of life in patients receiving treatment for brain metastases: a literature review.
abstract: BACKGROUND
  Brain metastases are a significant cause of morbidity and mortality for patients with advanced cancers, and quality-of-life (QoL) end points are most appropriate for this population. The Functional Assessment of Cancer Therapy (FACT) questionnaires are commonly used to assess cancer-related QoL issues. The FACT-Brain (FACT-Br) provides an additional set of disease-specific questions pertaining to brain neoplasms. We aim to provide a comprehensive review to examine the use of the FACT-Br as a QoL assessment for patients with brain metastases.
  
  
  METHODS
  A review of the literature was conducted and all studies utilizing the FACT-Br for QoL assessment of patients with brain metastases were included. Study information and relevant information regarding the FACT-Br were extracted.
  
  
  RESULTS
  A total of 14 studies were identified representing various treatment options (radiation, chemotherapy and surgery) for patients with brain metastases. All studies utilized at least part of the FACT-Br as the main QoL assessment. In addition, neurocognitive and performance status assessments were performed in nine and 12 out of 14 studies, respectively. Issues of poor accrual, compliance and attrition were common and posed problems in reaching statistically significant changes in QoL despite changes in raw QoL scores.
  
  
  CONCLUSIONS
  Studies involving patients with brain metastases should continue to utilize QoL tools such as the FACT-Br; however, this tool still requires validation for use in this patient population. Additional studies should observe the relationship between neurocognitive function and QoL, and attempt to minimize poor accrual and compliance issues through modifications of trial design and reduction of patient burden.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Lien
authors.forename: Liang
authors.initials: L
authors.lastname: Zeng
authors.forename: Janet
authors.initials: J
authors.lastname: Nguyen
authors.forename: Gemma
authors.initials: G
authors.lastname: Cramarossa
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.forename: Eric
authors.initials: E
authors.lastname: Chang
authors.forename: Amanda
authors.initials: A
authors.lastname: Caissie
authors.forename: Lori
authors.initials: L
authors.lastname: Holden
authors.forename: Shaelyn
authors.initials: S
authors.lastname: Culleton
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D001932:Brain Neoplasms / Q000523:psychology / Q000556:secondary / Q000628:therapy*; D006801:Humans; D009483:Neuropsychological Tests; D010166:Palliative Care; D011237:Predictive Value of Tests; D011594:Psychometrics; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome