Qualitative longitudinal analysis of symptoms in patients with primary and metastatic brain tumours.

Primary and metastatic brain tumour patients are treated with surgery, radiation therapy and chemotherapy. Such treatments often result in short- and long-term symptoms that impact cognitive, emotional and physical function. Therefore, understanding the transition of symptom burden over time is important for guiding treatment and follow-up of brain tumour patients with symptom-specific interventions. We describe the use of a hidden Markov model with person-specific random effects for the temporal pattern of symptom burden. Clinically relevant covariates are also incorporated in the analysis through the use of generalized linear models.