Narrative review of neurocognitive and quality of life tools used in brain metastases trials

Development of brain metastases are common in patients with advanced malignancies leading to significant morbidity and mortality. Although overall survival is an important endpoint in these patients, neurocognition and health related quality of life (HRQoL) more accurately highlights the impact of the disease and its treatment on patients. Whole brain radiotherapy (WBRT) has historically played a key role in the management of these patients, especially those with multiple brain metastases. Clinical trials have supported the use of stereotactic radiosurgery (SRS) alone in patients with limited brain metastases sparing neurocognitive function and HRQoL as compared to the combination of SRS plus WBRT. Furthermore, new systemic agents are increasingly being used in clinical practice and have shown promise in patients with brain metastases. The upcoming clinical trials are tasked with defining treatment guidelines that are more specific to patient and tumour factors incorporating radiation, surgery, and systemic therapy. The validity of findings in these trials rest on the rigor of the study methodology and the utilisation of validated assessment tools for neurocognition and HRQoL. This review aims to appraise and summarise the neurocognitive and HRQoL tools used in modern brain metastases trials.