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Impact of socio-economic factors on radiation treatment after resection of metastatic brain tumors: trends from a private insurance database

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Abstract

Background

Stereotactic radiosurgery (SRS) to the surgical bed of resected brain metastases is now considered the standard of care due to its advantages over whole brain radiation therapy (WBRT). Despite the upward trend in SRS adoption since the 2000s, disparities have been reported suggesting that socio-economic factors can influence SRS utilization.

Objective

To analyze recent trends in SRS use and identify factors that influence treatment.

Methods

We conducted a retrospective cohort study with the Optum Commercial Claims and Encounters Database and included all patients from 2004 to 2021 who received SRS or WBRT within 60 days after resection of tumors metastatic to the brain.

Results

A total of 3495 patients met the inclusion and exclusion criteria. There were 1998 patients in the SRS group and 1497 patients in the WBRT group. SRS use now supersedes WBRT by a wide margin. Lung, breast and colon were the most common sites of primary tumor. Although we found no significant differences based on race among the treatment groups, patients with annual household income greater than $75,000 and those with some college or higher education are significantly more likely to receive SRS (OR 1.44 and 1.30; 95% CI 1.18–1.76 and 1.08–1.56; P = 0.001 and 0.005, respective). Patients with Elixhauser Comorbidity Index of three or more were significantly more likely to receive SRS treatment.

Conclusion

The use of post-surgical SRS for brain metastasis has increased significantly over time, however education and income were associated with differential SRS utilization.

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Abbreviations

CPT:

Current procedural terminology

CI:

Confidence interval

OR:

Odds ratio

SRS:

Stereo-tactic radiosurgery

WBRT:

Whole brain radiotherapy

QoL:

Quality of life

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Funding

Anand Veeravagu, MD receives support from the Arkadi Khulman Fund. David Dadey, MD, PhD receives support from the Stanford Neurosurgery Equity Seed Grant.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Stanford University Medical Center, 453 Quarry Road, Stanford, CA, 94304, USA

    David Y. A. Dadey, Ghani Haider, John R. Adler & Anand Veeravagu

  2. School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, 94305, USA

    Adrian Rodrigues

  3. Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA

    Erqi L. Pollom

Authors
  1. David Y. A. Dadey
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Contributions

DD: conceptualization, methodology, writing—original draft, project administration. AR: methodology, formal analysis, visualization, writing—original draft. GH: writing—methodology, original draft. EP: writing—review & editing JA: conceptualization, writing—review & editing. AV: conceptualization, writing—review & editing, supervision, funding acquisition.

Corresponding author

Correspondence to David Y. A. Dadey.

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Conflict of interest

John Adler, MD is an employee of Zap Surgical Systems Inc. Erqi L. Pollom, MD, MS is on the advocacy board for Vysioneer and receives research funding from Genentech.

Ethical approval

This observational study was not considered human subject research and received exemption from Institutional Review Board approval at our institution.

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Dadey, D.Y.A., Rodrigues, A., Haider, G. et al. Impact of socio-economic factors on radiation treatment after resection of metastatic brain tumors: trends from a private insurance database. J Neurooncol 158, 445–451 (2022). https://doi.org/10.1007/s11060-022-04031-6

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  • DOI: https://doi.org/10.1007/s11060-022-04031-6

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