93 Individual Cognitive Trajectories Post-Radiotherapy for Brain Metastases DISCUSSION In order to be able to provide patient-tailored cancer care, including personalized psycho-education, we first need individualized research to inform on the effects of cancer treatment on individuals. Therefore, the aim of this study was to evaluate the individual trajectories of subjective and objective cognitive performance after radiotherapy in patients with BMs both at the short-term (i.e. 3 months) and at the long-term (i.e. ≥11 months) to provide insight into the cognitive impact of treatment. Our findings demonstrate that on a group-level, the incidence of patients displaying cognitive decline is counterbalanced by those demonstrating improvements within the same cognitive domain. The individualized results reveal a nuanced picture, where the majority of patients who exhibit improvements in one domain also experience a decline in another. Thus, impact of radiotherapy on cognitive performance is complex and multidimensional. The cognitive impact of radiotherapy was also subjectively reported by the majority of patients. Using VAS, patients were able to provide a differentiated profile of subjective cognitive decline over time. Three months post-radiotherapy, half of the patients experienced a decline in subjective cognitive performance, most frequently involving attention and thinking. In the long-term, memory complaints were more prominent. Considering that intracranial progression emerged as a risk factor for self-reported cognitive decline 3 months post-radiotherapy, these cognitive complaints may primarily reflect new or aggravated symptoms resulting from the presence of new BMs. Based on previous research, it was anticipated that the specific cognitive domains would not fully align with those observed in the objective cognitive assessment.23,31 However, there was a consistency between the number of patients reporting subjective cognitive decline and those demonstrating objective cognitive decline. To illustrate, patients may have reported complaints in attention, while these were objectively reflected by worse memory performance. This underlines that while patients may label cognitive complaints differently, it is essential to incorporate subjective assessments to also capture patients’ experiences of cognitive difficulties. Regarding objective cognitive performance, multiple cognitive domains were affected post-radiotherapy, rather than a single domain universally affected in all patients. Nevertheless, memory appeared to be particularly susceptible to the negative effects of treatment, reflected by the 75% of patients exhibiting declined memory performance and 80% of patients with a memory impairment 3 months post-radiotherapy and 75% of patients exhibiting declined memory performance 4
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