(P114) Radiotherapeutic Care Within the Veterans Health Administration of US Veterans With Metastatic Cancer to the Brain: Supportive Measures (Part 1 of 2 Reports)

Publication
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OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Veterans with brain metastases treated at VHA radiation oncology centers receive appropriate care. Still, the use of prognostic indices in treatment decision-making is statistically significantly more likely in cases treated by recent training program graduates. Given the relatively recent development of these scoring systems, educational efforts need to be devoted to increasing their use in the clinic.

George A. Dawson, MD, Shruti Jolly, MD, Helen Fosmire, MD, Maria Kelly, MD, Stephen Lutz, MD, Micheal Hagan, MD, PhD, Ruchika Gutt, MD, Drew Moghanaki, MD, MPH, Lori Hoffman-Hogg, MS, RN, CNS, AOCN, Mitchell Ancher, MD, Alice Cheuk, MD; US Veterans Healthcare Administration National Palliative Radiotherapy Task Force

Metastatic cancer to the brain is estimated to occur in 170,000 Americans annually. Of them, over 600 cases occur in US veterans. Management of brain metastases is complex. Prognostic scoring criteria and evidence-based guidelines have been developed by societies, including the American Society of Radiation Oncology (ASTRO), to provide guidance in the care of patients with metastatic brain cancer. Patterns of care among Veterans Health Administration radiation oncologists (VHA ROs) in the treatment of brain metastases are not known.

METHOD: An electronic survey was sent to all (82) VHA ROs at 38 active VHA radiation oncology centers. Follow-up phone calls were made to nonresponders. The survey inquired about supportive measures, including the number of brain metastases consults seen per year, steroid usage and dosing, use of the Radiotherapy Oncology Group (RTOG)-recursive partitioning analysis (RPA) or diagnosis-specific graded prognostic assessment (GPA) prognostic score, onsite availability of stereotactic radiosurgery (SRS), and demographics. Additional information about VHA ROs regarding their employment status, years in practice, and academic appointments was also obtained.

RESULTS: A total of 62 of 82 VHA ROs responded to the questionnaire (76%). Most respondents had academic appointments (70%). Most respondents (79%) received more than 10 consults annually. A total of 89% only used steroids in the setting of neurological changes or edema, while ~10% always used steroids for brain metastases. Prognostic scores for brain metastases were used routinely by only 42% of VHA ROs. The RTOG-RPA classification was used the most (73%). Physicians in practice for less than 5 years (P = .024) and full-time employees (P < .001) were more likely to use prognostic scoring. Also, 69% of surveyed sites referred to another VA or VA-contracted facility for SRS services when required (31% + SRS onsite).

The most common dexamethasone dose was 16 mg/day, used by 54% of the respondents.

CONCLUSIONS: Veterans with brain metastases treated at VHA radiation oncology centers receive appropriate care. Still, the use of prognostic indices in treatment decision-making is statistically significantly more likely in cases treated by recent training program graduates. Given the relatively recent development of these scoring systems, educational efforts need to be devoted to increasing their use in the clinic.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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