Care pathways for asymptomatic brain metastases: comparison of healthcare utilization, costs, and outcomes in outpatient versus acute settings.

PURPOSE: Incidentally found brain metastases often lead to emergency room referrals even in asymptomatic patients-a pathway of care that could be unnecessary. We sought to compare time and financial toxicity, and treatment outcomes between a multidisciplinary outpatient (MP) and acute care pathways (AP).

METHODS

Patients referred for de novo asymptomatic brain metastases at an NCI-designated Cancer Center with a Multidisciplinary Brain Metastasis Program were identified via retrospective review. Scans, encounters, time to local interventions, and survival data were collected and compared.

RESULTS

Seventy-eight patients were identified, 47 referred to MP and 31 AP. Both groups had similar disease-specific prognostic scores and received similar treatments. Patients managed via AP had larger dominant lesions (2.9 cm vs. 2.0 cm, p < 0.002) and shorter time to therapy (13.7 days vs. 9.2 days; p = 0.047). AP patients also had more medical-encounter (7.1 vs. 2.5; p < 0.001) and admitted days (5.9 vs. 1.1; p < 0.001), with increased median gross charge amount ($185,961 vs. $126,831; p = 0.003) despite similar 6-month survival (83% MP vs. 81% AP, p > 0.999) and local tumor control (95% MP vs. 96% AP, p = 0.849).

CONCLUSION

Patients with asymptomatic brain metastases managed through an outpatient pathway attained similar disease outcomes with lower time and financial toxicity compared to patients managed through inpatient pathways. Characteristics of such patients that qualify them for outpatient pathway should be confirmed prospectively.