Trent Kite, Teigan Dwyer, Charlotte Drury-Gworek, Tyson Barrett, John Herbst, Rachel Ombres, Leah Herbst, Stephen Karlovits, Rodney E Wegner, Matthew J Shepard
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Survival trends and healthcare utilization rates following treatment were analyzed across each frailty group.</p><p><strong>Results: </strong>A total of 9927 patients were retrospectively analyzed. Overall survival (OS) was significantly decreased in the frail and severely frail groups compared to pre-frail patients (frail: HR: 1.55, 95% CI: 1.33-1.80, <i>P</i> < .0001) and (severely frail: HR: 2.12, 95% CI: 1.84-2.44, <i>P</i> < .0001). Increased healthcare utilization was observed after SRS in frail and severely frail patients (frail: 90-day RR 1.07, 180-day RR 1.08. and 1-year RR 1.10, <i>P</i> < .0001; severely frail: 90-day RR 1.16, 180-day RR 1.18, 1-year RR 1.21, <i>P</i> < .0001). In patients with established palliative care involvement at the time of SRS, healthcare utilization rates were decreased in the frail and severely frail groups.</p><p><strong>Conclusion: </strong>Increasing frailty scores portended reduced OS with increased overall healthcare utilization rates. The introduction of palliative care prior to SRS decreased healthcare utilization rates across frailty cohorts.</p>","PeriodicalId":94157,"journal":{"name":"Neuro-oncology advances","volume":"7 1","pages":"vdaf186"},"PeriodicalIF":4.1000,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449133/pdf/","citationCount":"0","resultStr":"{\"title\":\"The role of palliative care at the time of stereotactic radiosurgery on healthcare utilization for frail patients with brain metastases.\",\"authors\":\"Trent Kite, Teigan Dwyer, Charlotte Drury-Gworek, Tyson Barrett, John Herbst, Rachel Ombres, Leah Herbst, Stephen Karlovits, Rodney E Wegner, Matthew J Shepard\",\"doi\":\"10.1093/noajnl/vdaf186\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The 5-factor modified frailty index (mFI-5) has been increasingly studied in the context of patients with central nervous system tumors. Previously, studies have demonstrated an inverse relationship between increasing mFI-5 scores and overall/progression-free survival in patients with brain metastases (BMs) undergoing stereotactic radiosurgery (SRS).</p><p><strong>Methods: </strong>A single payer insurance database was queried for patients undergoing SRS for BMs. Patients were stratified based on mFI-5 scores as follows: pre-frail (0-1), frail (2), and severely frail (≥ 3). Survival trends and healthcare utilization rates following treatment were analyzed across each frailty group.</p><p><strong>Results: </strong>A total of 9927 patients were retrospectively analyzed. Overall survival (OS) was significantly decreased in the frail and severely frail groups compared to pre-frail patients (frail: HR: 1.55, 95% CI: 1.33-1.80, <i>P</i> < .0001) and (severely frail: HR: 2.12, 95% CI: 1.84-2.44, <i>P</i> < .0001). Increased healthcare utilization was observed after SRS in frail and severely frail patients (frail: 90-day RR 1.07, 180-day RR 1.08. and 1-year RR 1.10, <i>P</i> < .0001; severely frail: 90-day RR 1.16, 180-day RR 1.18, 1-year RR 1.21, <i>P</i> < .0001). In patients with established palliative care involvement at the time of SRS, healthcare utilization rates were decreased in the frail and severely frail groups.</p><p><strong>Conclusion: </strong>Increasing frailty scores portended reduced OS with increased overall healthcare utilization rates. The introduction of palliative care prior to SRS decreased healthcare utilization rates across frailty cohorts.</p>\",\"PeriodicalId\":94157,\"journal\":{\"name\":\"Neuro-oncology advances\",\"volume\":\"7 1\",\"pages\":\"vdaf186\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2025-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449133/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuro-oncology advances\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/noajnl/vdaf186\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuro-oncology advances","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/noajnl/vdaf186","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：5因子修正衰弱指数（mFI-5）在中枢神经系统肿瘤患者中的研究越来越多。先前的研究表明，在接受立体定向放射手术（SRS）的脑转移（BMs）患者中，mFI-5评分的增加与总体/无进展生存之间存在反比关系。方法：对脑转移患者进行SRS的单一付款人保险数据库进行查询。根据mFI-5评分对患者进行分层：前期虚弱（0-1）、虚弱(2)和严重虚弱（≥3）。分析每个虚弱组治疗后的生存趋势和医疗保健利用率。结果：共对9927例患者进行回顾性分析。与体弱前患者相比，体弱组和严重体弱组的总生存期（OS）显著降低（体弱：HR: 1.55, 95% CI: 1.33-1.80, P P P P P P）。结论：体弱评分的增加预示着总体医疗利用率的提高会降低OS。在SRS之前引入姑息治疗降低了弱势群体的医疗利用率。
The role of palliative care at the time of stereotactic radiosurgery on healthcare utilization for frail patients with brain metastases.
Background: The 5-factor modified frailty index (mFI-5) has been increasingly studied in the context of patients with central nervous system tumors. Previously, studies have demonstrated an inverse relationship between increasing mFI-5 scores and overall/progression-free survival in patients with brain metastases (BMs) undergoing stereotactic radiosurgery (SRS).
Methods: A single payer insurance database was queried for patients undergoing SRS for BMs. Patients were stratified based on mFI-5 scores as follows: pre-frail (0-1), frail (2), and severely frail (≥ 3). Survival trends and healthcare utilization rates following treatment were analyzed across each frailty group.
Results: A total of 9927 patients were retrospectively analyzed. Overall survival (OS) was significantly decreased in the frail and severely frail groups compared to pre-frail patients (frail: HR: 1.55, 95% CI: 1.33-1.80, P < .0001) and (severely frail: HR: 2.12, 95% CI: 1.84-2.44, P < .0001). Increased healthcare utilization was observed after SRS in frail and severely frail patients (frail: 90-day RR 1.07, 180-day RR 1.08. and 1-year RR 1.10, P < .0001; severely frail: 90-day RR 1.16, 180-day RR 1.18, 1-year RR 1.21, P < .0001). In patients with established palliative care involvement at the time of SRS, healthcare utilization rates were decreased in the frail and severely frail groups.
Conclusion: Increasing frailty scores portended reduced OS with increased overall healthcare utilization rates. The introduction of palliative care prior to SRS decreased healthcare utilization rates across frailty cohorts.
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