59 Pre-Radiotherapy Cognitive Profiles in Patients with Brain Metastases INTRODUCTION Brain metastases (BMs) occur in 10-30% of the adult cancer population and this incidence continues to rise.1,2 Thereby, BMs are the most common type of brain tumor.3 Median overall survival despite systemic and local treatment is limited, spanning months to several years, depending on factors such as number of BMs, Karnofsky performance status (KPS)4, and the primary tumor.5–7 Treatment for BMs consists of different options, including radiotherapy, surgery, chemotherapy, immunotherapy or a combination.8 In this vulnerable population, treatment (shared) decisions are tailored toward gaining the best disease control while maintaining acceptable quality of life (QoL) during the remaining life span. Already before starting BMs-specific treatment, a large percentage of patients experience cognitive problems; half of the patients demonstrate cognitive impairment on minimally one cognitive domain.9–12 Multiple cognitive domains can be affected, with impairments reported in memory, executive function, and processing speed. However, substantial variability exists both within and between subjects in terms of cognitive domains of dysfunction. The pathogenesis of this pre-treatment cognitive performance is still incompletely understood, but both tumor-related factors (e.g. primary cancer, number of BMs) as well as treatmentrelated factors (e.g. previous chemotherapy) seem involved.11,13–15 Previous research predominantly focused on cognitive performance on grouplevel using a confined set of cognitive tests. However, the heterogeneity of this patient population calls for a more individualized approach using an elaborate test battery. This will aid thorough understanding of the cognitive vulnerabilities and offer valuable insights for tailoring future interventions and optimizing patientcentered care. Therefore, the main aim was to extensively describe and classify the cognitive performance of patients with BMs before brain radiotherapy, using both group- and individual statistics. Additionally, we used hierarchical cluster analysis to provide data-driven comprehensive understanding of the cognitive deficits and their interconnections. Additionally, we assessed the added value of an elaborate versus a core test battery in defining cognitive functioning of this heterogeneous population. 3
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