Survey Finds Disparities In Care Of Patients with Metastatic Brain Tumors

In In The News by Barbara Jacoby

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From: PR Newswire

Findings Reinforce the Need to Increase Clinical Trial Accessibility, Standardize Treatment Recommendations and Improve Physician-Patient Communication

A first-of-its-kind, 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 (BM). The survey results have been published open access in the journal Neuro-Oncology Practice.

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 BM.

“It is critical that patients with brain metastases have more clinical trial options,” said one of the study’s last authors, Priscilla Brastianos, M.D., associate professor of medicine and director of the CNS Metastasis Center at Mass 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%) compared to academic physicians (40%) are significantly more likely to recommend whole brain radiation (WBRT). Academic physicians (56%) are also more likely to recommend cognitive-sparing stereotactic radiosurgery (SRS). While WBRT was the gold standard for BM for several decades, many oncologists have recently eschewed WBRT in favor of SRS for BM, 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 BM. 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 author 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.”

Survey Methodology
This cross-sectional online survey of patients, caregivers and physicians, conducted online by Penn, Schoen, and Berland (PSB) on behalf of the ABTA, analyzed approximately 200 responses from each cohort. The patient and caregiver survey was conducted August 13-September 16, 2018 and the physician survey was conducted June 16-25, 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 BM.

About the Metastatic Brain Tumor Initiative
Metastatic brain tumors are the most common type of brain tumors in adults. Current estimates suggest approximately 50,000 to 150,000 adults are diagnosed annually in the U.S. Unfortunately, the average prognosis has historically been in the order of a few months. Lung, breast, melanoma, kidney, and colon cancers are the most common primary cancers leading to brain metastases.

As the leader of brain tumor education, support services and research, the ABTA created the Metastatic Brain Tumor Initiative to inform, support and empower patients diagnosed with a metastatic brain tumor. Partner organizations include the Kidney Cancer Association, Living Beyond Breast Cancer, LUNGevity Foundation, Melanoma Research Foundation, and the Society for Neuro-Oncology.

About the American Brain Tumor Association
Founded in 1973, the American Brain Tumor Association provides comprehensive resources to support the complex needs of brain tumor patients and caregivers, across all ages and tumor types, as well as the critical funding of research in the pursuit of breakthroughs in brain tumor diagnoses, treatments and care. To learn more, visit abta.org or call 800-886-ABTA (2282).