Comprehensive Evaluation of Fatigue in Brain Metastasis Patients Pre- and Post-Gamma Knife Radiosurgery
Overview
This study assessed multidimensional fatigue in patients with brain metastases (BM) before and up to 6 months after Gamma Knife radiosurgery (GKRS), comparing them to matched non-cancer controls. Findings revealed that BM patients experience significantly higher fatigue levels than controls, with fatigue dimensions influenced more by psychological factors and performance status than tumor characteristics.
Background
Brain metastases are the most common brain tumors, with increasing patient survival due to improved systemic treatments. Fatigue is a prevalent and distressing symptom in cancer and brain tumor patients, negatively impacting quality of life and functioning. Prior studies on BM patients used unidimensional fatigue measures, limiting understanding of fatigue's complex nature. This study employed a multidimensional fatigue inventory to better characterize fatigue before and after GKRS and explored clinical and psychological predictors.
Data Highlights
The study included adult patients with 1–10 BM scheduled for GKRS and matched non-cancer controls. Fatigue was measured using the Multidimensional Fatigue Inventory (MFI), assessing general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation. Fatigue scores were converted to age- and sex-corrected Z scores based on control data. Follow-up assessments occurred at baseline, 3 months, and 6 months post-GKRS. Tumor response was categorized as partial response, stable disease, or progressive disease based on MRI volumetric criteria.
Key Findings
Patients with BM reported significantly higher levels of fatigue across multiple dimensions compared to non-cancer controls at baseline.
Fatigue levels increased over 6 months following GKRS, with 61% of patients reporting increased fatigue at 3 months post-treatment in prior related studies.
Multidimensional fatigue assessment revealed distinct fatigue components, including mental and physical fatigue, providing a more nuanced understanding than unidimensional measures.
Psychological factors such as anxiety and depression were more strongly associated with fatigue levels than tumor volume, number of metastases, or treatment parameters.
Lower Karnofsky Performance Status (KPS < 90) was linked to worse fatigue outcomes, highlighting functional status as a key predictor.
Fatigue was clustered with deterioration in global health status, underscoring its impact on overall quality of life.
Clinical Implications
Clinicians should recognize that fatigue in BM patients is multifaceted and influenced more by psychological and functional status than tumor burden or treatment specifics. Multidimensional fatigue assessment tools can aid in identifying specific fatigue domains to target for intervention. Addressing anxiety, depression, and performance status may help mitigate fatigue and improve patient quality of life post-GKRS.
Conclusion
Multidimensional fatigue is a significant and complex symptom in patients with brain metastases undergoing Gamma Knife radiosurgery, influenced predominantly by psychological and functional factors rather than tumor characteristics. Comprehensive fatigue assessment and management should be integrated into clinical care to enhance patient outcomes.
References
Rijnen et al. 2019 -- Fatigue in patients with brain metastases before and after stereotactic radiosurgery
