2174 - Baseline and Time Dependent Predictors of Worsened Quality of Life, Symptoms of Depression, Anxiety, and Self-Reported Cognition: A Secondary Analysis of the ATHENA Trial
Presenter(s)
H. K. Perlow1, Y. Sun2, L. Chen2, E. Dawson3, K. Dibs4, A. Ritter4, B. De5, R. Singh6, S. Beyer6, S. Zhu6, D. M. Blakaj4, J. C. Grecula4, R. Raval6, C. Presley7, C. Pillainayagam8, P. Giglio9, A. Baydoun1, M. Berman10, E. M. Thomas4, and J. D. Palmer6; 1University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, 2Case Western Reserve University School of Medicine, Cleveland, OH, 3Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, 4Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 5Department of CNS Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Radiation Oncology, James Cancer Hospital/Wexner Medical Center, The Ohio State University, Columbus, OH, 7Department of Medical Oncology, The Ohio State University James Cancer Center, Columbus, OH, 8Department of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Columbus, OH, 9Division of Neuro-Oncology, Ohio State University, Columbus, OH, 10Department of Neurology, Cleveland, OH
Purpose/Objective(s):
Brain metastasis patients experience changes in intracranial disease status and systemic therapy exposure that may influence quality of life (QOL), mood, and self-reported cognition over time. Prior analyses from this cohort demonstrate that baseline intracranial disease burden, intracranial progression, and systemic progression were more predictive of objective cognitive decline than radiation technique, age, number of brain metastases, or systemic therapy administration. This secondary analysis of a Phase 2 randomized trial (NCT05503251) evaluated baseline characteristics and time-varying clinical factors associated with longitudinal changes in QOL, depressive symptoms, anxiety, and self-reported cognition following brain-directed radiotherapy.Materials/Methods:
This is a secondary analysis of a clinical trial in which patients with brain metastases were randomized 1:1 to either brain radiation alone or brain radiation with neuropsychologist evaluation and intervention. The primary endpoint, change in QOL three months after completion of radiotherapy measured by Functional Assessment of Cancer Therapy (FACT-Br), was not met. Patients were assessed using the FACT-Br, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Patient-Reported Outcomes Measurement Information System-8 (PROMIS-8) to evaluate QOL, severity of anxiety and depression symptoms, and self-reported cognition. To account for informative dropout due to mortality, joint longitudinal–survival models were used to evaluate associations between predictors and outcome trajectory slopes (predictor × time interaction). Both baseline characteristics and time-varying clinical events were screened. Predictors with p < 0.1 were advanced to multivariable models adjusted for treatment arm, age, and baseline performance status.Results:
110 brain metastasis patients were enrolled. 106, 86, 58, 52, and 42 patients completed testing at baseline, 3, 6, 9, and 12 months. On multivariable analysis, receipt of chemotherapy was associated with worsened symptoms of depression (PHQ-9) over time (trajectory change = 0.321 points/month; 95% CI: 0.026–0.606; p = 0.03). Higher baseline performance status was associated with better initial QOL (Fact-Br) and self-reported cognitive symptoms (PROMIS-8), though this advantage attenuated over the 12-month follow-up period (FACT-Br: trajectory change = -0.098 points/month, p = 0.04; PROMIS-8: trajectory change = -0.987 points/month, p = 0.01). No baseline or time-varying clinical variables were significantly associated with anxiety (GAD-7) trajectory.Conclusion: For brain metastasis patients, receipt of chemotherapy and baseline performance status are predictive of changes in important patient reported outcomes such as QOL, self-reported cognitive symptoms, and symptoms of depression. Understanding the trajectory of these measures may allow for better targeting of therapeutic interventions.