Nested Cohort Study to Identify Characteristics That Predict Near-Term Disablement From Lung Cancer Brain Metastases.
OBJECTIVE
To test whether the presence of patient- and imaging-level characteristics (1) are associated with clinically meaningful changes in mobility among patients with late-stage cancer with metastatic brain involvement, and (2) can predict their risk of near-term functional decline.


METHODS
Prospective nested cohort study.


METHODS
Quaternary academic medical center.


METHODS
The study population consisted of a nested cohort of the patients with imaging-confirmed brain metastases (n=66) among a larger cohort of patients with late-stage lung cancer (N=311).


METHODS
Not applicable.


METHODS
Functional evaluations with the Activity Measure for Post-Acute Care Computer Adaptive Test (AM-PAC-CAT) and symptom intensity ratings were collected at monthly intervals for up to 2 years.


RESULTS
In exploratory univariate models, whole brain radiation therapy (WBRT) and imaging findings of cerebellar or brainstem involvement were associated with large AM-PAC-CAT score declines reflecting worsening mobility (-4.55, SE 1.12; -2.87, SE, 1.0; and -3.14, SE 1.47, respectively). Also in univariate models, participants with new neurologic signs or symptoms at imaging (-2.48; SE .99), new brain metastases (-2.14, SE .99), or new and expanding metastases (-2.64, SE 1.14) declined significantly. Multivariate exploratory mixed logistic models, including WBRT, cerebellar/brainstem location, presence of new and expanding metastases, and worst pain intensity, had excellent predictive capabilities for AM-PAC-CAT score declines of 7.5 and 10 points (C statistics ≥0.8).


CONCLUSIONS
Among patients with lung cancer and brain metastases, cerebellar/brainstem location, new and expanding metastases, and treatment with WBRT may predict severe, near-term mobility losses and indicate a need to consider rehabilitation services.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: Cheville.andrea@mayo.edu.
Andrea L
AL
Cheville
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
Jeffrey R
JR
Basford
Department of Neurosurgery, Mayo Clinic, Rochester, MN.
Ian
I
Parney
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Ping
P
Yang
Department of Radiology, Mayo Clinic, Rochester, MN.
Felix E
FE
Diehn
D000368:Aged; D001932:Brain Neoplasms / Q000503:physiopathology / Q000534:rehabilitation* / Q000556:secondary*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D019467:Subacute Care
Decision support techniques; Lung neoplasms; Mobility limitation; Neoplasm metastasis; Radiotherapy; Rehabilitation
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