82 Chapter 4 within this heterogeneous group, considering subjective experiences, and focusing on long-term effects. METHODS Study set-up and population Study procedures have been described previously.23 Data was prospectively collected from the Cohort for patient-reported Outcomes, Imaging and trial inclusion in Metastatic BRAin disease (COIMBRA, NCT05267158) and the 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 metastatic brain disease referred to the University Medical Center Utrecht (UMCU) for brain radiotherapy. For both studies, neurocognitive assessments (NCAs), including semi-structured interviews, were performed before, 3 months and ≥11 months after radiotherapy. The studies were performed in accordance with the Declaration of Helsinki24 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 Semi-structured interview Prior to each neurocognitive assessment (NCA), subjective cognitive experience was assessed using a semi-structured interview. For the current analyses, the subjective cognitive ratings using the visual analogue scales (VAS) were used. In brief, patients were asked to assess their performance regarding thinking, memory, attention, perception, language and processing speed using VAS, similar to Schoo and colleagues.25 The VAS consisted of a 100 mm vertical line on A3-sized paper, where the top (+) represents perfect performance and the bottom (-) represents worst performance. Patients marked the line at their experienced premorbid performance level (i.e. prior to the primary cancer diagnosis and antitumor treatment) as well as their current experience. This resulted in an intra-individual estimation ranging from 0 (-) to 100 (+). A difference score was calculated for each cognitive concept to assess change in performance. This was categorized into stable performance (±5), subtle improvement or decline (±6-25), substantial improvement or decline (±26-50) and extreme improvement or decline (±>50).
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