Disparities in the treatment of brain metastases from breast cancer: Insights from the National Cancer Database.

Abstract

2037 Background: Breast cancer is the most common malignancy in women accounting for over 300,000 cases per year. Unfortunately, brain metastases are found in a sub-group of patients with breast cancer even at presentation. Management of brain metastases typically includes radiotherapy with conventional whole brain radiation therapy (WBRT) or more focused stereotactic radiosurgery (SRS). We queried the National Cancer Database (NCDB) to analyze the incidence of brain metastases at diagnosis in breast cancer patients, as well as trends in radiation use/technique. Methods: The NCDB was queried for patients who were diagnosed with breast cancer between 2004-2015 and had brain metastasis at presentation (N = 4,491). We excluded patients without brain radiation and inadequate follow up. Odds ratios were calculated to identify factors associated with treatment. Multivariable cox regression was used to determine predictors of survival. Results: Using the eligibility criteria above 1,505 patients were identified in the NCDB. The cohort had a median age of 58 years. A small portion were uninsured (7%) population uninsured and 81% of radiation treatments were delivered in metropolitan areas. Two hundred sixty-one (17.3%) patients received SRS while 1,244 (82.7%) received WBRT. Those patients with private insurance, higher income, metro location, and having care delivered at an academic center were more likely to receive SRS. Conversely, the likelihood of receiving WBRT was significantly higher in those with luminal type cancer, African Americans, the uninsured, and those located in urban areas or treated at a community cancer center. On Cox regression, predictors of worse survival were age > 60 with Hazard Ratio (HR) 1.3 (95% CI 1.17-1.49), a comorbidity score > 2 with HR 1.45 (95% CI 1.1-1.9), and extra cranial metastatic disease with HR 1.33 (95% CI 1.15-1.54). Conclusions: This analysis of the NCDB demonstrates socioeconomic and demographic disparities in the treatment of patients with brain metastases from breast cancer. There is a continued need to reduce these disparities and improve access to care for at-risk populations affected by this highly prevalent malignancy.