Self-reported cognitive outcomes in patients with brain metastases before and after radiation therapy.
OBJECTIVE
Patients with brain metastases may experience treatment-related cognitive deficits. In this study, we prospectively assessed the self-reported cognitive abilities of patients with brain metastases from any solid primary cancer before and after irradiation of the brain.


METHODS
The treatment group (TG) consisted of adult patients (n=50) with brain metastases who received whole or partial irradiation of the brain without having received prior radiation therapy (RT). The control group (CG) consisted of breast cancer patients (n=27) without cranial involvement who were treated with adjuvant RT. Patients were recruited between May 2008 and December 2010. Self-reported cognitive abilities were acquired before RT and 6 weeks, 3 months, and 6 months after irradiation. The information regarding the neurocognitive status was collected by use of the German questionnaires for self-perceived deficits in attention (FEDA) and subjectively experienced everyday memory performance (FEAG).


RESULTS
The baseline data showed a high proportion of self-perceived neurocognitive deficits in both groups. A comparison between the TG and the CG regarding the course of self-reported outcomes after RT showed significant between-group differences for the FEDA scales 2 and 3: fatigue and retardation of daily living activities (P=.002) and decrease in motivation (P=.032) with an increase of attention deficits in the TG, but not in the CG. There was a trend towards significance in FEDA scale 1: distractibility and retardation of mental processes (P=.059) between the TG and the CG. The FEAG assessment presented no significant differences. An additional subgroup analysis within the TG was carried out. FEDA scale 3 showed significant differences in the time-related progress between patients with whole-brain RT and those receiving hypofractionated stereotactic RT (P=.025), with less decrease in motivation in the latter group.


CONCLUSIONS
Self-reported attention declined in patients with brain metastases after RT to the brain, whereas it remained relatively stable in breast cancer patients.
Department of Radiation Oncology, Medical School Hannover, Hannover, Germany.
Ansa Maer
AM
Cole
Angela
A
Scherwath
Gundula
G
Ernst
Heinrich
H
Lanfermann
Michael
M
Bremer
Diana
D
Steinmann
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000523:psychology / Q000532:radiotherapy; D003071:Cognition / Q000502:physiology / Q000528:radiation effects*; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008568:Memory / Q000502:physiology / Q000528:radiation effects; D008606:Mental Processes / Q000502:physiology / Q000528:radiation effects; D008875:Middle Aged; D009042:Motivation / Q000502:physiology / Q000528:radiation effects; D011446:Prospective Studies; D011594:Psychometrics; D057566:Self Report; D011795:Surveys and Questionnaires; D013997:Time Factors