Patient-reported Symptoms Differ Between Patients With Brain Metastasis Starting Either Focal Stereotactic...

The presence of brain metastasis is often associated with clinical symptoms and reduced quality-of life scores, potentially triggering palliative care needs. Previous studies have employed the Edmonton symptom assessment system (ESAS) to this end. However, contemporary patient-reported ESAS data from cohorts managed with different radiotherapy techniques rather than whole-brain radiotherapy (WBRT) alone are scarce. Therefore, the aim of this study was to compare ESAS symptom severity before WBRT to that before stereotactic radiosurgery or fractionated radiotherapy (SRS/FSRT).

This was a retrospective analysis (2013-2024, n=102) of patients with brain metastasis assessed with ESAS in routine clinical practice in Norway. Patients were stratified based on radiotherapy approach (WBRT±boost versus SRS/FSRT). ESAS scores of 0 correspond to absence of symptoms (maximum intensity: 10).

For the whole study group, fatigue and overall wellbeing scores were highest (mean 3.9 and 3.4, respectively). The lowest scores were those for nausea and constipation (mean 1.2 and 1.4, respectively). Within the WBRT cohort, no significant differences were observed between ESAS scores of boost versus no boost patients. When comparing WBRT to SRS/FSRT, we found that WBRT patients reported significantly higher anxiety scores (mean 2.6 vs. 1.1, p=0.03). Similar trends emerged for fatigue (mean 4.1 vs. 2.7, p=0.056, i.e., not significant) and overall wellbeing (mean 3.7 vs. 2.5, p=0.087). The sum of symptom scores was significantly higher in the WBRT cohort (mean 31.7), compared to the SRS/FSRT cohort (mean 18.5), p=0.03.

When employing ESAS screening to provide additional palliative care services to patients with brain metastasis who start radiotherapy, clinicians should be aware of the fact that patients undergoing WBRT may have worse symptom burden and higher needs than patients undergoing SRS/FSRT. This is particularly evident for anxiety, fatigue and overall wellbeing, and not explained by differences in number of brain metastasis and diagnostic setting (regular imaging surveillance versus clinical trigger).