Socioeconomic, Racial Disparities Persist in Management of Brain Metastases
The growing use of effective treatment strategies for metastatic cancer in the brain has not been documented in certain patient populations, according to research published in the Journal of the National Comprehensive Cancer Network (2017;15:1494-1502).
The management of brain metastases typically includes radiotherapy with conventional fractionation and stereotactic radiosurgery. However, optimal indications and practice patterns for stereotactic radiosurgery remain unclear.
Benjamin H Kann, MD, department of therapeutic radiology, Yale University School of Medicine, and colleagues conducted a study to evaluate national practice patterns for patients with metastatic disease receiving brain radiotherapy. Researchers used the National Cancer Data Base to identify 75,953 patients diagnosed with metastatic non-small cell lung cancer, breast cancer, colorectal cancer, or melanoma from 2004 through 2014 who received upfront brain radiotherapy. Patients were divided into stereotactic (n = 12,250; 16.1%) and non-stereotactic (n = 63,703; 83.9%) radiosurgery cohorts.
Researchers noted that over the course of the study period, the proportion of patients receiving stereotactic radiosurgery increased annually from 9.8% to 25.6% (P < .001). Likewise, the proportion of facilities using stereotactic radiosurgery increased annually from 31.2% to 50.4% (P < .001).
Multivariable analysis showed that non-white race, non-private insurance, and residence in lower-income or less-educated regions were predictive of lower stereotactic radiosurgery use (P < .05 for each). During the study period, stereotactic radiosurgery use increased disproportionally among patients with private insurance or among those who resided in higher-income or higher-educated regions.
From 2004 through 2013, the 12-month actuarial survival improved from 24.1% to 49.6% for patients selected for stereotactic radiosurgery and from 21.0% to 26.3% for patients who did not receive stereotactic radiosurgery (P < .001).
Researchers concluded that while the study demonstrated steadily increasing brain stereotactic radiosurgery use for patients with metastatic disease in the United States, there are multiple widening sociodemographic disparities in the adoption of such a treatment strategy. “Further research is needed to determine the reasons for these worsening disparities and their clinical implications on intracranial control, neurocognitive toxicities, quality of life, and survival for patients with brain metastases,” they wrote.—Zachary Bessette