Cross-sectional survey of patients, caregivers, and physicians on diagnosis and treatment of brain metastases

Abstract

Background The development of brain metastases (BM) is one of the most feared complications of cancer due to the substantial neuro-cognitive morbidity and grim prognosis. In the past decade, targeted therapies and checkpoint inhibitors have demonstrated promising intracranial response rates for tumors of multiple histologies. As overall survival for these patients improves, there is a growing need to identify issues surrounding patient survivorship and to standardize physician practice patterns for these patients. To date, there has not been an adequate study to specifically explore these questions of survivorship and practice standardization for patients with advanced cancer and BM. Methods Here, we present results from a cross-sectional survey in which we analyze responses from 237 patients, 209 caregivers, and 239 physicians to identify areas of improvement in the clinical care of BM. Results In comparing physician and patient/caregiver responses, we found a disparity in the perceived discussion of topics pertaining to important aspects of BM clinical care. We identified variability in practice patterns for this patient population between private practice and academic physicians. Many physicians continue to have patients with BM excluded from clinical trials. Finally, we obtained patient/physician recommendations on high-yield areas for federal funding to improve patient quality of life. Conclusion By identifying potential areas of unmet need, we anticipate this wealth of actionable information will translate into tangible benefits for both patients and caregivers. Future studies are needed to validate our findings.

Tucatinib vs Placebo, Both in Combination With Trastuzumab and Capecitabine, for Previously Treated ERBB2 (HER2)-Positive Metastatic Breast Cancer in Patients With Brain Metastases

“…Neurosurgery, radiosurgery, and whole-brain radiotherapy are often used to treat BMs; however, these techniques can lead to neurologic toxic effects and reduce patients’ quality of life . Despite the high prevalence and their poor prognosis, patients with BMs, especially those with active or untreated BMs, have been historically excluded from early- and late-stage clinical trials . Hence, there is a substantial need for tolerable systemic treatment options to treat established BMs and reduce the risk for progression in the central nervous system (CNS).…”

“…11,17 Despite the high prevalence and their poor prognosis, patients with BMs, especially those with active or untreated BMs, have been historically excluded from early-and latestage clinical trials. [18][19][20][21][22] Hence, there is a substantial need for tolerable systemic treatment options to treat established BMs and reduce the risk for progression in the central nervous system (CNS).…”

IMPACT the Brain: A Team-Based Approach to Management of Metastatic Breast Cancer With CNS Metastases

“…41 Participation is likely less for patients with CNS metastases, as the presence of brain metastases excludes or restricts patient enrollment in many clinical trials. [42][43][44] This limits the evidence for care delivery for patients with MBC and CNS metastases. Both ASCO and the US Food and Drug Administration have recognized the need to include this subset of patients in research.…”

Radiation Oncology Virtual Education Rotation (ROVER) 2.0 for Residents: Implementation and Outcomes

“…A common feedback point revealed a critical advantage of this platform: effective multi-institutional panelist discussion (Table 3), with an appreciation for discussion of practice variation and differing treatment approaches (a request of 70% of respondents on the pre-survey). Radiation oncology exhibits strong practice variation between geographies and institutions [15][16][17], partly related to differences in available technologies, but even beyond that based on training, varying adoption of new studies [17], practice setting (i.e., academic versus private practice [16]), and inherent clinical equipoise for many topics in our field. Thus, our panelists, which were deliberately constructed with an eye to speaker diversity, allowed for thoughtful discussion of varying treatment approaches.…”