Neuro-oncology advances · 2025
The role of palliative care at the time of stereotactic radiosurgery on healthcare utilization for frail patients with brain metastases.
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Kite Trent, Dwyer Teigan, Drury-Gworek Charlotte, Barrett Tyson, Herbst John, Ombres Rachel, Herbst Leah, Karlovits Stephen, Wegner Rodney E, Shepard Matthew J
Аннотация
BACKGROUND: The 5-factor modified frailty index (mFI-5) has been increasingly studied in the context of patients with central nervous system tumors. Previously, studies have demonstrated an inverse relationship between increasing mFI-5 scores and overall/progression-free survival in patients with brain metastases (BMs) undergoing stereotactic radiosurgery (SRS).
METHODS: A single payer insurance database was queried for patients undergoing SRS for BMs. Patients were stratified based on mFI-5 scores as follows: pre-frail (0-1), frail (2), and severely frail (≥ 3). Survival trends and healthcare utilization rates following treatment were analyzed across each frailty group.
RESULTS: A total of 9927 patients were retrospectively analyzed. Overall survival (OS) was significantly decreased in the frail and severely frail groups compared to pre-frail patients (frail: HR: 1.55, 95% CI: 1.33-1.80, P < .0001) and (severely frail: HR: 2.12, 95% CI: 1.84-2.44, P < .0001). Increased healthcare utilization was observed after SRS in frail and severely frail patients (frail: 90-day RR 1.07, 180-day RR 1.08. and 1-year RR 1.10, P < .0001; severely frail: 90-day RR 1.16, 180-day RR 1.18, 1-year RR 1.21, P < .0001). In patients with established palliative care involvement at the time of SRS, healthcare utilization rates were decreased in the frail and severely frail groups.
CONCLUSION: Increasing frailty scores portended reduced OS with increased overall healthcare utilization rates. The introduction of palliative care prior to SRS decreased healthcare utilization rates across frailty cohorts.
METHODS: A single payer insurance database was queried for patients undergoing SRS for BMs. Patients were stratified based on mFI-5 scores as follows: pre-frail (0-1), frail (2), and severely frail (≥ 3). Survival trends and healthcare utilization rates following treatment were analyzed across each frailty group.
RESULTS: A total of 9927 patients were retrospectively analyzed. Overall survival (OS) was significantly decreased in the frail and severely frail groups compared to pre-frail patients (frail: HR: 1.55, 95% CI: 1.33-1.80, P < .0001) and (severely frail: HR: 2.12, 95% CI: 1.84-2.44, P < .0001). Increased healthcare utilization was observed after SRS in frail and severely frail patients (frail: 90-day RR 1.07, 180-day RR 1.08. and 1-year RR 1.10, P < .0001; severely frail: 90-day RR 1.16, 180-day RR 1.18, 1-year RR 1.21, P < .0001). In patients with established palliative care involvement at the time of SRS, healthcare utilization rates were decreased in the frail and severely frail groups.
CONCLUSION: Increasing frailty scores portended reduced OS with increased overall healthcare utilization rates. The introduction of palliative care prior to SRS decreased healthcare utilization rates across frailty cohorts.