P11.23.B PSYCHO-ONCOLOGICAL BURDEN IS REDUCED FOLLOWING NEUROSURGICAL RESECTION OF BRAIN METASTASES

Abstract BACKGROUND Most patients with brain metastases (BM) have a high psycho-oncological burden. This aspect may negatively affect the course of the disease and treatment outcome. Neurosurgical and neurooncological departments treat increasing numbers of patients with BM. So far, no data on the efficacy of surgical treatment on psycho-oncological distress exist. Therefore, we analyzed the extent of psycho-oncological burden in a patient population with BM before and after neurosurgical resection, comparing pre- and postsurgical screening results. The study aims to establish whether neurosurgical therapy may reduce psycho-oncological distress in our patient cohort. MATERIAL AND METHODS We included 103 patients (45 female, 58 male) with a median age of 59.8 years, who were planned to receive a microsurgical resection of BM between January 2016 and January 2024. The most frequent primary tumors were lung (40.8%), melanoma (27.2%) and breast cancer (7.8%). Psycho-oncological screening was performed using the Hornheider Screening Instrument (HSI) in 84.5% and the distress thermometer (DT) in 15.5% of all cases. Postsurgical screening was performed after a median duration of 4.5 days (range: 2 - 42 days). The postsurgical Karnofsky score (KPS) was 90% (range: 50 - 100%), surgical complications occurred in 26 patients (25.2%), with worsening of a preexisting neurological deficit (13.6%) and wound complications (6.8%) as the most frequent forms of complications. RESULTS 16.00 Comparing pre- and postsurgical screening results, 17 patients (16.5%) stayed stable, 47 patients (45.6%) improved, and 39 patients (37.9%) showed an increased psycho-oncological distress. The improvement rate of patients with a progressive disease, both intracranially and systemically, was significantly inferior to that of patients with a stable disease (16.6% vs. 47.4%, p = 0.033). From the population screened presurgically, 46 patients (44.7%) reached a score beyond the predefined threshold and required psycho-oncological treatment. Postsurgically, the fraction of patients requiring intervention dropped significantly to 41.8% (p = 0.020). The postsurgical HSI score was significantly reduced from a median of 4 (range: 1 - 10) to 3 (range: 1 - 10; p = 0.036). In contrast, the DT values did not show a significant change postsurgically (p = 0.431). CONCLUSION Neurosurgical resection may significantly reduce the psycho-oncological burden in patients with brain metastases. Psycho-oncological improvement is more evident in patients with stable intracranial and extracranial disease.