Physician expectations of treatment outcomes for patients with brain metastases referred for whole brain radiotherapy.
OBJECTIVE
Patients with advanced cancer are referred to our Rapid Response Radiotherapy Program for quick access to palliative radiotherapy. The primary objective of this prospective study was to determine the physician expectations of the treatment outcomes for patients with brain metastases referred for whole brain radiotherapy (WBRT). The secondary objectives were to determine the factors influencing the expectations and to examine the accuracy of the physician-estimated patient survival.


METHODS
Patients were identified during a 17-month period. The referring physicians were sent a survey by facsimile to be completed and returned before the patient consultation. Information was sought on the patient's disease status, the physician's expectations of WBRT, the estimated patient survival and performance status, and physician demographic data.


RESULTS
A total of 137 surveys were sent out, and the overall response rate was 57.7%. The median patient age was 66 years (range, 35-87), 78.5% had multiple brain metastases, 42.3% had a controlled primary tumor, and 62.3% had extracranial disease. WBRT was thought to stabilize neurologic symptoms, improve quality of life, and allow for a Decadron (dexamethasone) taper by > or =94.9% of the referring physicians; 87.0% thought WBRT would improve performance status; 77.9% thought it would improve neurologic symptoms; and 40.8% thought it would improve survival. The referring physicians estimated patient survival as a median of 6.0 months; however, the actual survival was a median of 2.5 months, for a median individual difference of 1.9 months (p < .0001).


CONCLUSIONS
Physicians referring patients with brain metastases for consideration of WBRT are often overly optimistic when estimating the clinical benefit of the treatment and overestimate patient survival. These findings highlight the need for education and additional research in this field.
Barnes
Elizabeth A
EA
Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Toronto, ON, Canada. toni.barnes@sunnybrook.ca
Chow
Edward
E
Tsao
May N
MN
Bradley
Nicole M
NM
Doyle
Meagan
M
Li
Kathy
K
Lam
Kelvin
K
Danjoux
Cyril
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D016371:Cranial Irradiation / Q000379:methods* / Q000401:mortality; D003907:Dexamethasone / Q000008:administration & dosage; D005938:Glucocorticoids / Q000008:administration & dosage; D006305:Health Status Indicators; D006801:Humans; D017567:Karnofsky Performance Status; D008017:Life Expectancy; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D003907:Dexamethasone