A cross-sectional survey of patients, caregivers, and physicians on the diagnosis and treatment of brain metastases, conducted by the American Brain Tumor Association (ABTA) as part of its Metastatic Brain Tumor Initiative, revealed disparities in practice patterns and communication around metastatic brain tumors. These data highlight the need to increase accessibility to clinical trials, establish clear standards of care, and improve physician-patient communication reflective of the unique needs of patients with brain metastases. The survey results were published by Kim et al in Neuro-Oncology Practice.
This cross-sectional online survey of patients, caregivers, and physicians—conducted by Penn, Schoen, and Berland on behalf of the ABTA—analyzed approximately 200 responses from each cohort. The patient and caregiver survey was conducted from August 13 to September 16, 2018, and the physician survey was conducted from June 16 to 25, 2019. Surveyed patients were adults diagnosed with brain metastases, caregivers providing support to a patient with brain metastases, and physicians providing direct clinical care to patients diagnosed with brain metastases.
Responses Reveal Shortcomings
Survey data overwhelmingly revealed the critical need to increase accessibility and availability to clinical trials by both academic and private practice physicians. More than half of the physicians surveyed indicated more clinical trials are needed. Participation in a clinical trial was among the least recommended treatment options. In addition, the majority of academic (72%) and private practice (59%) physicians reported that one or more of their patients was denied participation in clinical trials specifically due to the presence of brain metastases.
It is critical that patients with brain metastases have more clinical trial options. 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.— Priscilla Brastianos, MD
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“It is critical that patients with brain metastases have more clinical trial options,” said corresponding study author Priscilla Brastianos, MD, Associate Professor of Medicine and Director of the Central Nervous System Metastasis Center at Massachusetts General Cancer Center. “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.”
Survey data also identified disparities in recommended treatment options among private practice and academic physicians. Data suggests private practice physicians (61%) are significantly more likely to recommend whole-brain radiation (WBRT) compared to academic physicians (40%). Academic physicians (56%) are also more likely to recommend cognitive-sparing stereotactic radiosurgery (SRS). While WBRT was the gold standard for brain metastases for several decades, many oncologists have recently eschewed WBRT in favor of SRS for brain metastases, due to the risk of neurotoxicity and the lack of improvement in quality of life or overall survival with WBRT.
Possible rationale for the discrepancy in treatment recommendations may be an outcome of how physicians approach them. Survey data shows academic physicians were more likely to consider clinical research and treatment toxicity in their decision-making process, whereas private practice physicians were more concerned about treating neurologic symptoms.
The survey also revealed a disparity in the perceived discussion of topics pertaining to brain metastases. For example, only 48% of patients said they were informed of symptoms to be aware of, but 80% of physicians responded that they discussed this topic with their patients.
“While treatment and care of patients with brain metastases presents unique challenges for the physician and patient, this survey sheds some light on interventions needed to address the complex and unique needs of this patient population,” said Nicole Willmarth, PhD, Chief Mission Officer of the ABTA and coauthor of the study. “Through the ABTA Metastatic Brain Tumor Initiative, it is our intent to collaborate with the medical oncology and brain tumor communities to better address these unmet needs and help deliver better outcomes for this patient population.”
Disclosure: For full disclosures of the study authors, visit academic.oup.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.