Disparities in Follow-Up Care, Outcomes After Radiosurgery for Brain Metastasis

09/14/17

Researchers have identified follow-up care and outcomes disparities for patients with brain metastasis treated with stereotactic radiosurgery in a private hospital compared with those treated in a safety-net hospital.

Stereotactic radiosurgery has recently become an accepted treatment for brain metastasis. However, undergoing stereotactic radiosurgery requires adherence to frequently scheduled follow-up neuroimaging due to an increased risk of distant brain metastasis. The effects of disparities in access to follow-up care and outcomes after such a treatment is unknown.

Kevin Diao, BA, Harvard Medical School, and Keck School of Medicine, University of Southern California, and colleagues conducted a retrospective study to evaluate for the effects of disparities in access to follow-up care and outcomes for patients with stereotactic radiosurgery-treated brain metastasis. A total of 153 patients were selected who were treated with stereotactic radiosurgery alone from 2010 through 2016 at an academic medical center or a safety-net hospital in California.

Researchers assessed for a variety of outcomes, including neurologic symptoms, hospitalization, steroid use and dependency, salvage stereotactic radiosurgery, salvage whole-brain radiotherapy, salvage neurosurgery, and overall survival. Results of the analysis were published in Cancer (online September 13, 2017; doi:10.1002/cncr.30984).

Researchers acknowledged that 93 of the patients were treated in a private hospital, while the remaining 60 patients were treated in a safety-net hospital.

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After a median follow-up time of 7.7 months, patients treated in the safety-net hospital received fewer follow-up neurologic studies than those treated in the private hospital (1.5 vs 3, respectively; P = .008). Multivariate analysis showed that the safety-net hospital setting was a significant risk factor for salvage neurosurgery (HR, 13.65; P < .001), neurologic symptoms (HR, 3.74; P = .002), and hospitalization due to brain metastases (HR, 6.25; P < .001).

Additionally, researchers noted that more clinical visits were protective against hospitalizations due to brain metastases (HR, 0.75: P = .002), whereas more neuroimaging studies were protective against death (HR, 0.65; P < .001).

Authors of the study concluded that patients treated with stereotactic radiosurgery for brain metastasis in a safety-net hospital are less likely to receive adhere to follow-up neuroimaging and are more likely to exhibit neurologic symptoms, be hospitalized for distant metastases, and require salvage neurosurgery in comparison with patients treated in a private hospital. “Clinicians should consider the practice setting and patient access to follow-up care when they are deciding on the optimal strategy for the treatment of brain metastases,” they wrote.—Zachary Bessette