title: Correlating symptoms and their changes with survival in patients with brain metastases.
abstract: OBJECTIVE
  Having a clear prognosis for patients with brain metastases allows health care practitioners (HCPs) to determine appropriate palliative management and assist patients when making informed treatment decisions. The objective of this study was to determine the prognostic significance of commonly experienced symptoms as well as their changes.
  
  
  METHODS
  Overall survival (OS) was calculated from the date of consultation for palliative radiotherapy to date of death or censored at last follow-up date. Symptom changes at follow up were defined as worsened, improved, or no change. Univariate and multivariate cox proportional hazard (PH) model of OS was conducted on 14 symptoms at baseline and on changes in those symptoms at 1-, 2-, and 3-month follow-ups.
  
  
  RESULTS
  From 1999 to 2013, 1,660 patients were included for baseline symptom analysis. Through univariate analysis, fatigue, nausea, appetite loss, coordination, concentration, balance and depression were significantly related to OS. Upon multivariate analysis, fatigue and appetite loss were most predictive of short survival. For symptom change, 201 patients were included. The actuarial median OS was 5.0 months [95% confidence interval (CI): 4.3-7.0], 7.1 months (95% CI: 5.2-9.5) and 8.8 months (95% CI: 5.8-11.5) for patients with month 1, 2, and 3 follow-ups, respectively. The most common symptom changes following whole brain radiotherapy (WBRT) were: worsened fatigue, appetite loss, and weakness. Worsened difficulty concentrating, fatigue, nausea and headaches were most predictive of a poorer survival outcome.
  
  
  CONCLUSIONS
  HCPs should be aware of the shorter prognosis associated with patients exhibiting one or more of these symptoms and tailor care accordingly to maximize patients' remaining quality of life (QOL).
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Wong
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Leigha
authors.initials: L
authors.lastname: Rowbottom
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: McDonald
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chan
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. edward.chow@sunnybrook.ca.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary*; D001943:Breast Neoplasms / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D014057:Tomography, X-Ray Computed; D014565:Urogenital Neoplasms / Q000401:mortality; D055815:Young Adult
keywords: Brain metastases; survival; symptoms