Andrea L Cheville1, Jeffrey R Basford2, Ian Parney3, Ping Yang4, Felix E Diehn5. 1. Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: Cheville.andrea@mayo.edu. 2. Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. 3. Department of Neurosurgery, Mayo Clinic, Rochester, MN. 4. Department of Health Sciences Research, Mayo Clinic, Rochester, MN. 5. Department of Radiology, Mayo Clinic, Rochester, MN.
Abstract
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. DESIGN: Prospective nested cohort study. SETTING: Quaternary academic medical center. PARTICIPANTS: 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). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 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.
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. DESIGN: Prospective nested cohort study. SETTING: Quaternary academic medical center. PARTICIPANTS: 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). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 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.
Authors: Andrea L Cheville; Steven R Alberts; Teresa A Rummans; Jeffrey R Basford; Maria I Lapid; Jeff A Sloan; Daniel V Satele; Matthew M Clark Journal: J Pain Symptom Manage Date: 2015-05-12 Impact factor: 3.612
Authors: Wendy J Coster; Stephen M Haley; Patricia L Andres; Larry H Ludlow; Tamara L Y Bond; Peng-Sheng Ni Journal: Med Care Date: 2004-01 Impact factor: 2.983
Authors: Nicole L Stout; Justin C Brown; Anna L Schwartz; Timothy F Marshall; Anna M Campbell; Larissa Nekhlyudov; David S Zucker; Karen M Basen-Engquist; Grace Campbell; Jeffrey Meyerhardt; Andrea L Cheville; Kelley R Covington; Jennifer A Ligibel; Jonas M Sokolof; Kathryn H Schmitz; Catherine M Alfano Journal: Cancer Date: 2020-03-25 Impact factor: 6.860