Article Abstract

Radiotherapy for brain metastases near the end of life in an integrated health care system

Authors: Joan J. Ryoo, Michael Batech, Chengyi Zheng, Raymond W. Kim, Michael K. Gould, A. Robert Kagan, Winston W. Lien


Background: To examine radiotherapy (RT) patterns-of-care and utilization at the end of life (EOL) among non-small cell lung cancer (NSCLC) patients with brain metastasis (BrM) in an integrated health care system.
Methods: Central tumor registry identified 5,133 patients diagnosed with NSCLC from 2007–2011. BrM were determined by imaging. Patient and clinical characteristics were obtained by chart abstraction. In addition to abstracted variables, graded prognostic assessment (GPA) score of 0-1 was derived by collected data and tested as a predictor of death within 14 or 30 days of RT.
Results: On NSCLC presentation, 10% harbored BrM while 7% developed BrM thereafter. Of 900 BrM patients, 15% were not referred for RT, with median time to death of 21 days. Median time to death for 5% not recommended RT was 48 days. Among those receiving brain RT, 11.9% died within 14 days and 23.3% (cumulatively) died within 30 days of treatment. Over 50% with GPA score 0–1 received RT, 11% within 14 days and 21% within 30 days of death; median survival of GPA score 0–1 patients was 49 days. GPA score 0–1 independently predicted for death within 30 days of RT receipt.
Conclusions: BrM are common in NSCLC, and most patients are referred for brain RT. A surprising proportion of patients received treatment near the EOL, as 23% died within 30 days of RT. GPA score of 0–1 predicted for death within 30 days of treatment. RT referral, recommendation, and timing should be better tailored to life expectancy, and additional benchmarks for quality of care are needed.