KEY POINTS
- The prospective NeuroPRO study included 63 patients receiving radiotherapy for brain metastases and generated 4,448 matched clinician- and patient-reported symptom comparisons from 278 questionnaires.
- Treatment reflected contemporary practice: 81% received stereotactic radiotherapy and 19% whole-brain radiotherapy. Forty percent had previously received cranial radiotherapy, and 56% received concurrent systemic therapy.
- Patients reported greater symptom severity than clinicians for 27 of 32 assessed symptoms (84%), indicating systematic underestimation of symptom burden by clinician assessment alone.
- Agreement was poorest for symptoms that are difficult to observe directly. Gwet’s AC2 was only 0.30 for worry, 0.39 for depression, and 0.44 for drowsiness, compared with 0.96 for vomiting, 0.94 for seizures, and 0.92 for nausea.
- The largest mean clinician-patient discrepancies occurred for dyspnea, 1.00 severity grade, insomnia, 0.76, and depression, 0.75, all with p < 0.001.
- The discordance was broadly stable from baseline through end of radiotherapy and first follow-up, suggesting a persistent perception gap rather than a transient treatment-phase effect.
- Patient-reported overall health remained stable, quality of life temporarily declined at treatment completion and recovered by follow-up, while moderate-to-high decision regret occurred in only 6.1% of patients.
CLINICAL TAKEAWAY
Clinician assessment alone misses a meaningful part of the symptom burden experienced by patients receiving radiotherapy for brain metastases, particularly emotional, sleep-related and less visible symptoms. Routine patient-reported outcome screening could improve recognition and supportive care, although this remains a small single-centre observational study.