60 Chapter 3 METHODS Study set-up and population Data was prospectively collected from the Cohort for patient-reported Outcomes, Imaging and trial inclusion in Metastatic BRAin disease (COIMBRA, NCT05267158) and Assessing and Predicting Radiation Influence on Cognitive Outcome using the cerebrovascular stress Test (APRICOT) study. The study population consisted of adult patients (≥18 years) with either radiographic and/or histologic proof of BMs referred to the University Medical Center Utrecht (UMCU) for radiotherapy. Patients were non-eligible if they were unable to understand the Dutch language or had developmental, psychiatric, or cognitive disorders that hindered the patients’ understanding of the informed consent procedure. For both studies, neurocognitive assessments (NCAs) were performed before, 3 months and ≥11 months after radiotherapy (see the Supplementary Materials for additional study procedures and exclusion criteria). The studies were performed in accordance with the Declaration of Helsinki16 and the UMCU institutional ethical review approved both the COIMBRA and APRICOT study (#18-642 and #18-747, respectively). Written informed consent was obtained from all participants prior to participation. Data collection Subjective cognitive complaints Prior to the NCA, subjective cognitive experience was assessed using a semistructured interview regarding complaints on six different cognitive domains (memory, orientation, attention & executive functioning, processing speed, language, emotions), comparable to the structured interview regularly used in neuropsychological settings (Supplementary Materials). Based on the answers and reported interference with everyday life, the neuropsychologist rated each domain as cognitive complaints present (yes/no). In order to be classified as present, one complaint per domain sufficed. Additionally, patients rated their subjective cognitive functioning regarding thinking, memory, attention, perception, language and processing speed using visual analogue scales (VAS), similar to Schoo and colleagues.17 The VAS consisted of a 100 mm vertical line on A3-sized paper, where the top represents perfect and the bottom worst performance. Patients marked the line at their previously experienced premorbid subjective functioning level (i.e. prior to the primary cancer diagnosis) as well as for their current level (i.e. prior to the radiotherapy). This resulted in an estimation ranging from 0 to 100. A difference score was calculated for each cognitive concept to assess change in subjective functioning compared to premorbid levels. This was categorized into stable (±5), subtle improvement/decline (±6-25), substantial improvement/decline (±26-50) and
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