QOL-37. Malignant Intracranial Tumor Patients’ Preoperative Quality-of-Life Measures Predict Post-Operative Outcomes

Abstract There is increasing interest in using patient-reported outcomes (PROs) to assess surgical appropriateness in patients with glioblastomas and metastatic brain lesions. This study examined associations between pre-operative patient-reported quality-of-life (QOL) measurements and post-operative health-related outcomes among patients with malignant intracranial tumors. A series of malignant intracranial tumor patients prospectively completed a pre-operative PROMIS-29 QOL survey. The survey assessed 8 subdomains: Physical Function, Fatigue, Pain Interference, Depression, Anxiety/Fear, Social Participation, Sleep Disturbance, and Pain Intensity. Multivariate logistic regressions analyzed associations between survey scores and patient demographics, perioperative risk factors, and postoperative outcomes. Secondary analyses compared glioblastoma and metastatic lesion subpopulations. Finally, the predictive ability of PROMIS-29 scores was compared to Karnofsky Performance Status (KPS), American Society of Anesthesiologists (ASA), and 5-factor modified Frailty Index (mFI-5) scores. This study included 58 patients (mean age 62.0 years; 46.6% female). Compared to the general US population, the overall cohort and metastatic lesion subpopulation pre-operatively had higher Anxiety/Fear (p<0.001) and lower Physical Function (p<0.001) scores. When adjusted for demographics, higher Physical Function scores were significantly associated with increased odds of home discharge (AOR=1.106; p=0.010), reduced 90-day readmission (AOR, 0.892; p=0.004), and lower 90-day mortality (AOR=0.861; p=0.021). Cox regression demonstrated Physical Function also predicted improved overall survival (HR=0.935, p=0.014). In the metastatic brain lesion subpopulation, higher Physical Function scores were associated with increased home discharge (OR=1.335; p= 0.023) while higher Anxiety/Fear scores were associated with worse odds of 90-day mortality (OR=1.514; p=0.044). Physical Function scores better predicted 90-day mortality (AUROC=0.832) than the ASA (0.538), KPS (0.501), or mFI-5 (0.487). Pre-operative QOL PROs, especially for Physical Function, are valuable predictors of discharge disposition, readmission, and mortality in patients with malignant intracranial tumors. These metrics may aid clinical decision-making and further research should investigate the predictive utility of longitudinal changes in PROs over time.