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Figure 1. Follow-up time periods. Bar chart depicting heterogeneity in follow-up time periods. Most studies collected quality-of-life data at 6 and 12 months; however, other intervals between these periods and after were dependent on investigator choice.
(Figure omitted. See article PDF.)
Brain metastases occur in approximately 20-40% of cancer patients during the course of disease [1] and are especially prevalent in those with lung, breast or gastrointestinal primary cancers [2]. A cause of significant morbidity and mortality, brain metastases can lead to rapid physical and neurological deterioration, causing symptoms such as headache, focal weakness, mental disturbances, gait and/or limb ataxia, seizures, problems with speech and visual and/or sensory disturbances [3].
For patients with brain metastases, the focus of treatment is palliative over curative, where goals are to alleviate symptoms and improve quality of life (QoL) rather than increase survival. As these symptoms can severely impact a patient's QoL, therapeutic interventions such as utilization of corticosteroids, whole brain radiation, surgery and radiosurgery may be employed. When left untreated, patients can expect a median survival of 1 month, while with treatment, the median survival rates increase up to 3-6 months [3-5]. As treatment results in only marginal gains to traditional end points such as survival, they are therefore less appropriate and QoL indicators are essential in measuring improvements achieved through treatment for this population.
Tools to assess a patient's general wellbeing diverge into two general categories: simple performance scales such as the Karnofsky score [6] to assess performance status and more comprehensive QoL assessments in which a patient or proxy performs a self-assessment regarding their wellbeing. In the latter case, a variety of disease-specific tools are available, such as the Functional Assessment of Cancer Therapy Brain Cancer Module (FACT-Br) [7] and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire BN20 module (EORTC QLQ-BN20) for assessment of patients with brain tumors [8].
The QLQ-BN20 is a module developed specifically to address QoL issues for patients with primary brain tumors and has been validated for this use [8]. It is often used as a supplement to either the core general questionnaires, QLQ-C15-PAL [9] or QLQ-C30 [10], and contains 20 questions spanning four domains all relevant to their disease. The self-assessed scale scores ranging...