title: Quality of life in patients with brain metastases using the EORTC QLQ-BN20+2 and QLQ-C15-PAL.
abstract: OBJECTIVE
  The 20-item European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Neoplasm (QLQ-BN20) is a validated quality-of-life (QOL) questionnaire for patients with primary brain tumors. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15 Palliative (QLQ-C15-PAL) core palliative questionnaire is a 15-item version of the core 30-item QLQ-C30 and was developed to decrease the burden on patients with advanced cancer. The combination of the QLQ-BN20 and QLQ-C30 to assess QOL may be too burdensome for patients. The primary aim of this study was to assess QOL in patients before and after treatment for brain metastases using the QLQ-BN20+2 and QLQ-C15-PAL, a version of the QLQ-BN20 questionnaire with 2 additional questions assessing cognitive functioning that were not addressed in the QLQ-C15-PAL.
  
  
  METHODS
  Patients with brain metastases completed the QLQ-C15-PAL and QLQ-BN20+2 questionnaires to assess QOL before and 1 month after radiation. Linear regression analysis was used to assess changes in QOL scores over time, as well as to explore associations between the QLQ-BN20+2 and QLQ-C15-PAL scales, patient demographics, and clinical variables. Spearman correlation assessed associations between the QLQ-BN20+2 and QLQ-C15-PAL scales.
  
  
  RESULTS
  Among 108 patients, the majority (55%) received whole-brain radiotherapy only, with 65% of patients completing follow-up at 1 month after treatment. The most prominent symptoms at baseline were future uncertainty (QLQ-BN20+2) and fatigue (QLQ-C15-PAL). After treatment, significant improvement was seen for the QLQ-C15-PAL insomnia scale, as well as the QLQ-BN20+2 scales of future uncertainty, visual disorder, and concentration difficulty. Baseline Karnofsky Performance Status was negatively correlated to QLQ-BN20+2 motor dysfunction but positively related to QLQ-C15-PAL physical functioning and QLQ-BN20+2 cognitive functioning at baseline and follow-up. QLQ-BN20+2 scales of future uncertainty and motor dysfunction correlated with the most QLQ-C15-PAL scales, including overall QOL (negative association) at baseline and follow-up.
  
  
  CONCLUSIONS
  After radiation, the questionnaires showed maintenance of QOL and improvement of QOL scores such as future uncertainty, which featured prominently in this patient population. It is proposed that the 37-item QLQ-BN20+2 and QLQ-C15-PAL, as opposed to the 50-item QLQ-BN20 and QLQ-C30, may be used together as a universal QOL assessment tool in this setting.
authors.affiliation: Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Caissie
authors.forename: Janet
authors.initials: J
authors.lastname: Nguyen
authors.forename: Emily
authors.initials: E
authors.lastname: Chen
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
authors.forename: Marc
authors.initials: M
authors.lastname: Kerba
authors.forename: Palmira Foro
authors.initials: PF
authors.lastname: Arnalot
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.forename: Lori
authors.initials: L
authors.lastname: Holden
authors.forename: Brita
authors.initials: B
authors.lastname: Danielson
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary*; D002170:Canada; D003071:Cognition / Q000502:physiology / Q000528:radiation effects; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012044:Regression Analysis; D013030:Spain; D011795:Surveys and Questionnaires / Q000592:standards*; D035501:Uncertainty