Socioeconomic and Racial Disparities in Management of Brain Metastases

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Benjamin H. Kann, MD

Benjamin H. Kann, MD

Increasing use of a potentially life-saving treatment for metastatic cancer is leaving many vulnerable patients behind, according to a new study from Yale Cancer Center/Smilow Cancer Hospital published by Benjamin H. Kann, MD, of Yale University School of Medicine, and colleagues in the Journal of the National Comprehensive Cancer Network.

The researchers looked into the use of stereotactic radiosurgery following radiotherapy to treat brain metastases in patients with melanoma, lung, breast, or colorectal cancers. They found that the use of stereotactic radiosurgery has increased dramatically, but unevenly, in recent years.

More than 20% of patients with cancer develop brain metastases. This study examined data from the National Cancer Database between 2004 and 2014, focusing on people older than age 18, who were treated with radiation to the brain for one of the four malignancies most associated with brain metastases in the United States. A total of 75,953 patients met the criteria for inclusion, 12,250 (16.1%) of whom received stereotactic radiosurgery.

Study Findings

The investigators found the overall utilization rate for stereotactic radiosurgery increased from 9.8% in 2004 to 25.6% in 2014, with the rate of uptake accelerating after 2008. Stereotactic radiosurgery use increased more for patients with income levels of $63,000 and above, as well as for those treated at academic facilities, living in areas with higher percentages of high school graduates, or possessing private insurance.

There were lower rates of stereotactic radiosurgery among patients with Medicare, Medicaid, or no insurance. Patients of black race or Hispanic ethnicity were less likely to be treated with this modality, even when the researchers excluded the melanoma data (which involve a predominantly white population).

The study found that from 2004 to 2013, 1-year actuarial survival improved from 24.1% to 49.6% for patients selected for stereotactic radiosurgery but only from 21.0% to 26.3% for non–stereotactic radiosurgery patients. However, it’s not clear whether receipt of stereotactic radiosurgery itself improves survival or whether this association is due to the favorable prognosis of the patients selected. Further research is needed to determine the reasons for these worsening disparities and their clinical implications. ■

Kann BH, et al: J Natl Compr Canc Netw 15:1494-1502, 2017.




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