Palliative Care and Quality Outcomes in Patients With Brain Metastases and Poor Prognosis: A Multi-Institutional...

To analyze the patterns of palliative care (PC) consultation for patients with brain metastases (BMETs) and its association with treatment, overall survival (OS), and quality metrics (eg, advance directives [ADs], hospice enrollment).

We performed a multi-institutional retrospective quality review of consecutive patients diagnosed with BMETs from 2017 to 2019. We collected patient demographics, cancer diagnosis, performance status, treatment, PC consultation, emergency department utilization, AD completion, hospice enrollment, and OS data. We included patients with a predicted survival of <1 year based on the Updated Recursive Partitioning Analysis model (U-RPA) classes 2B and 3.

Among 487 patients with newly diagnosed BMETs and (U-RPA) classes 2B and 3, 56% (n = 274) had a PC consultation. Patients who received and did not receive PC consults were equally likely to have cancer-directed therapies (stereotactic radiation, whole brain radiation therapy, systemic therapy) or best supportive care (BSC). Among patients who received BSC only, the PC consult rate was 61%. The median OS for all patients was 4.3 months, with no difference between patients with PC and non-PC consults. Patients receiving PC were significantly more likely to have an AD documented (P < .0001) and to enroll in hospice (P < .0001).

The involvement of PC services correlated with higher completion rates of ADs and increased hospice utilization, without compromising survival or significantly altering other treatment options. There is an unmet need for PC among patients with BMETs with poor prognosis.