A nested cohort study to identify characteristics that predict near-term disablement from lung cancer brain metastases

Publication date: Available online 22 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Andrea L. Cheville, Jeffrey R. Basford, Ian Parney, Ping Yang, Felix E. Diehn
ObjectivesTo test whether the presence of patient- and imaging-level characteristics: 1) are associated with clinically meaningful changes in mobility among late stage cancer patients with metastatic brain involvement; and 2) can predict their risk of near-term functional decline.DesignProspective nested cohort studySettingQuaternary academic medical centerParticipantsThe study population consisted of a nested cohort of the 66 patients with imaging confirmed brain metastases among a larger cohort of 311 patients with late stage lung cancer.InterventionsNot applicableMain OutcomesFunctional 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.ResultsIn exploratory univariate models, whole brain radiation therapy (WBRT) and imaging findings of cerebellar or brain stem involvement were associated with large AM-PAC-CAT declines in 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 neurological signs or symptoms at imaging (-2.48, SE 0.99), new brain metastases (-2.14, SE 0.99), 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.ConclusionsAmong patients with lung cancer and brain metastases, a 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.



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