Patient reported outcomes and cognitive measures in daily oncology practice

Improved cancer survival highlights the importance of understanding cognitive impairments and quality of life (QoL). This dissertation examines the role of patient-reported outcome measures (PROMs) and objective cognitive assessments in routine oncological care.
In patients with brain metastases, stereotactic radiosurgery (Gamma-Knife or LINAC) frequently resulted in cognitive decline, with age as a strong predictor. PROMs additionally revealed a significant decrease in QoL, particularly regarding physical functioning and fatigue. Comparing hippocampal-avoidance with standard prophylactic cranial irradiation in small-cell lung cancer showed no relevant benefit for QoL or cognitive functioning.
Among melanoma patients, those treated with neoadjuvant immune checkpoint inhibitors reported better long-term QoL and less fatigue compared to patients receiving adjuvant therapy, despite higher rates of acute toxicities.
In breast cancer, around 20% of patients developed mild cognitive impairment after chemotherapy according to NIA-AA criteria, with lower education and IQ as risk factors. Furthermore, about one-third reported new cognitive complaints within the first year after diagnosis, especially associated with (chemo-)immunotherapy and reduced role and emotional functioning.
A pilot study demonstrated that a stepwise care pathway combining PROMs with online cognitive testing is feasible and valuable for early identification of cognitive disorders. Finally, effective visualization and clear explanation of PROM results proved essential for their use in clinical practice.
This dissertation underscores that integrating PROMs and cognitive assessments facilitates early detection of impairments and supports the development of personalized survivorship care strategies.