Survey Reveals Disparities in Practice Patterns and Communication About Brain Metastases

Disparities surrounding the perceived discussion of risks and implications of brain metastases were made evident in a survey conducted between physicians and patients or caregivers, according to results from a cross-sectional survey published in Neuro-Oncology Practice.¹

In general, physicians surveyed thought topics such as a general overview of brain metastases, worrisome symptoms, treatment options, and patient advocacy resources were discussed more frequently than their patient or caregiver counterparts. These findings were consistent with prior data showing that patients with brain metastases may be making treatment decisions without full understanding the ramifications of therapy or with an overly optimistic view of their prognosis.

“We performed a large cross-sectional survey in which we compared responses from physicians, caregivers, and patients to identify areas of improvement in the clinical care of brain metastases,” wrote the investigators who were led by Albert E. Kim, MD. “Our study is one of the first studies tailored specifically for these patients, a unique population due to their neurocognitive sequelae and limited prognosis.”

A total of 237 patients, 209 caregivers, and 239 physicians completed the survey. Most patients and caregivers were Caucasian, were young or middle-aged adults, and had a college education. Most physicians were male (89.9%) and Caucasian, with most (78.2%) reporting as medical oncologists with 10 or more years of experience.

All patients had been diagnosed with brain metastases with a histologically confirmed disease from any metastatic solid tumor. A caregiver was defined as “an adult individual (eg, family members, nursing staff), who was not a clinician, that provided support (eg, medical, financial, emotional, physical) to a patient with a confirmed diagnosis of brain metastases.” Physicians were classified as those providing direct clinical care to patients with a brain metastases.

A higher percentage of patients and caregivers reported a desire for increased discussion on these pertinent issues related to brain metastases treatment when compared with physicians. Both patient/caregiver and physician respondents felt further discussion of the prognostic and therapeutic implications of brain metastases were preferred following a metastatic cancer diagnosis. Common points of conversation that patients and caregivers wanted more information included brain metastases survival rates, treatment options, and patient advocacy support.

Some of the most common questions asked by patients and caregivers of their physicians post-brain metastases diagnosis included worrisome symptoms, treatment options/success, and quality of life (QOL) impact. Between 80% and 90% of patients felt the information provided by physicians regarding social and financial support was helpful. Physicians commonly reported referring patients to support groups, published research, and online education tools.

When asked about their biggest concerns relating to a brain metastases diagnosis, physicians reported topics included neurologic symptoms, treatment options/success, and impact on patient QOL as being the most important. Compared with academic physicians (30.9%), physicians affiliated with private practices (50.0%) were more concerned with a patient’s neurologic symptoms (P = .019). On the other hand, academic physicians were more likely to be worried about the state of published research and patient eligibility for clinical trials.

Regarding treatment options, clinical trial was one of the least recommended options amongst both physicians and patients (23.0% vs 17.9%, respectively). The most popular treatment options included stereotactic radiosurgery, whole-brain radiation therapy, and chemotherapy.

“It is critical that patients with brain metastases have more clinical trial options,” one of the study authors, Priscilla Brastianos, MD, who is an associate professor of medicine and director of the CNS Metastasis Center at Massachusetts General Cancer Center, said in a press release.² “Historically, patients with a brain metastasis have been excluded from clinical trials. Expanding eligibility across all clinical trial phases is essential to discovering effective treatments for this population.”

Limitations of the study include a lack of diversity in the sample cohort which may limit the generalizability of the results. The authors indicated that future research should include patients with both symptomatic and asymptomatic metastases as well as include providers outside of the medical oncology sector.

“Our hope is that these findings are a first step towards planning larger studies that identify survivorship issues for a specific subset within the brain metastases population, evaluate the longitudinal impact of specific interventions on patient QoL, and obtain input from other physician specialists. Results from these studies may inspire future quality improvement measures to improve specific facets of the care of patients with brain metastases. These efforts will be instrumental towards improving outcomes for a dismal disease,” the investigators concluded.

References

• Kim AE, Wang GM, Waite KA, et al. Cross-sectional survey of patients, caregivers, and physicians on diagnosis and treatment of brain metastases. Neuro-Oncol Pract.Published online July 13, 2021. doi:10.1093/nop/npab042
• Survey Finds Disparities In Care Of Patients with Metastatic Brain Tumors. News release. American Brain Tumor Association. August 24, 2021. Accessed August 27, 2021. https://prn.to/3sS6wMa