226 Chapter 9 regardless of treatment choices and eventually aid in the disentangling of the different treatment effects. • Performing qualitative research into the topics surrounding treatment-related decision making that are relevant to patients and caregivers in order to guide the selection of patient outcomes in future studies. • Data-driven design of an efficient cognitive test battery that is sensitive to the wide variety of cognitive changes observed within the BMs population. As online testing may be able to provide multiple cognitive measures at the same time and can be completed from the comfort of the own home, this may be an ideal candidate in this setting. At the same time, such a compact test battery could aid patients in understanding their cognitive strengths and weaknesses and thereby easily provide opportunities for cognitive rehabilitation. • Increased attention for the inclusion of age and gender-matched healthy controls throughout both cognitive and MRI studies in order to better understand the subtle treatment specific changes. • Improving our understanding of the complex interplay between different factors underlying radiation-induced cognitive decline by performing a largescale collection of multifaceted MRI data, both in the short-term and long-term post-radiotherapy. Subsequently, data-driven cluster analysis can be used to identify specific subgroups of patients (e.g. intact brain reserve vs impaired brain reserve) or specifically vulnerable brain regions (e.g. cortical grey matter, white matter, neurogenic niches) which can be related to cognitive functioning. CONCLUDING REMARKS In conclusion, the studies presented in this thesis offer a foundation upon which future research endeavors can build, guiding and inspiring further investigations into the cognitive changes experienced by patients with BMs and facilitating a deeper understanding of its pathogenesis. The ultimate objective of this research is to equip clinicians with patient-tailored predictions, empowering patients and their loves ones to make informed decisions about their treatments, optimized for their unique circumstances. However, as illustrated throughout this discussion, the path towards achieving this goal is filled with numerous hurdles and challenges that need to be overcome in the future. The inherent heterogeneity of the patient population and the complexity of the problems calls for an equally complex and multifaceted research approach. Only through a collective integration of all pieces of the puzzle will we be able to achieve the necessary results and make meaningful optimizations in the healthcare for future patients with BMs.
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