Dexamethasone toxicity and quality of life in patients with brain metastases following palliative whole-brain radiotherapy

Abstract

Objective: Corticosteroids are often one of the first treatments administered to relieve brain metastases symptoms; however, they are associated with unfavorable side effects with continued use. Whole-brain radiotherapy (WBRT) can relieve symptom burden due to the tumor as well as allow the patient to taper off of dexamethasone. The aim of this study was to prospectively assess the relationship between dexamethasone usage and symptoms and quality of life (QOL) in brain metastases patients undergoing palliative WBRT. Materials and methods: Brain metastases patients taking dexamethasone completed the Dexamethasone Symptom Questionnaire (DSQ) alongside the palliative core questionnaire, the EORTC QLQ-C15-PAL prior to palliative WBRT and at regular follow-up intervals thereafter until discontinuation of dexamethasone. Statistical analyses included general linear regression analysis, Fisher exact, and Kruskal-Wallis tests to assess relationships between dexamethasone dose/duration and the DSQ and QLQ-C15-PAL. Results: Sixty-eight patients were evaluable at baseline. Using the QLQ-C15-PAL, at week 2 post-WBRT patients on a higher dose of dexamethasone had worse physical (p = 0.0223) and emotional (p = 0.0082) functioning, and tended to score higher on fatigue (p = 0.0414) and dyspnea (p = 0.0117). When comparing dexamethasone dose with DSQ scores, a dose of >16 mg/day was significantly related to trouble getting to sleep (p = 0.009) at week 2 post-WBRT. Only less appetite loss on the QLQ-C15-PAL was significantly related to longer dexamethasone duration (p = 0.03) at baseline. Conclusion: This study is the first to use the DSQ and QLQ-C15-PAL to assess the impact of dexamethasone and WBRT on symptoms, functioning, and QOL in this patient group. Future investigations should determine the relationship between extended and high-dosage steroid use concurrently with WBRT and QOL in this patient group. © 2012 Springer-Verlag.