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Brain metastases are a significant cause of morbidity and mortality for patients with advanced cancers, and quality-of-life (QoL) end points are most appropriate for this population. The Functional Assessment of Cancer Therapy (FACT) questionnaires are commonly used to assess cancer-related QoL issues. The FACT-Brain (FACT-Br) provides an additional set of disease-specific questions pertaining to brain neoplasms. We aim to provide a comprehensive review to examine the use of the FACT-Br as a QoL assessment for patients with brain metastases.A review of the literature was conducted and all studies utilizing the FACT-Br for QoL assessment of patients with brain metastases were included. Study information and relevant information regarding the FACT-Br were extracted.A total of 14 studies were identified representing various treatment options (radiation, chemotherapy and surgery) for patients with brain metastases. All studies utilized at least part of the FACT-Br as the main QoL assessment. In addition, neurocognitive and performance status assessments were performed in nine and 12 out of 14 studies, respectively. Issues of poor accrual, compliance and attrition were common and posed problems in reaching statistically significant changes in QoL despite changes in raw QoL scores.Studies involving patients with brain metastases should continue to utilize QoL tools such as the FACT-Br; however, this tool still requires validation for use in this patient population. Additional studies should observe the relationship between neurocognitive function and QoL, and attempt to minimize poor accrual and compliance issues through modifications of trial design and reduction of patient burden.

Brain metastases occur in approximately 20-40% of cancer patients during the course of disease. As treatment for brain metastases is palliative over curative, quality of life (QoL) is emphasized over prolonged survival. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-BN20 is a QoL assessment specific to brain neoplasms. We aim to provide a review of the current use of the EORTC QLQ-BN20 for patients with brain metastases.All studies utilizing the QLQ-BN20 for QoL assessment in patients receiving treatments related to brain metastases were included. Study information including treatment type, assessment periods, patient enrolment and all information pertaining to the QLQ-BN20 were extracted.A total of 13 studies were identified, five of which were randomized trials assessing prophylactic whole brain radiation for patients with small-cell lung cancer. The QLQ-BN20 was used in conjunction with the core QLQ-C30 questionnaire in all but one of the studies and together these comprised the entire QoL assessments for 11 of the 13 studies. Neurocognitive function assessments supplemented QoL in four studies and accompanying performance status indices used with the QLQ-BN20 varied. Compliance issues were commonly cited. QoL changes during study periods varied as improvements, deteriorations and stabilizations were all observed.QoL assessments should be conducted using disease-specific tools. Future studies should minimize patient burden in order to maximize data collection and accrual. A common set of QoL end points for patients with brain metastases should be created.