NCTQ-08 OPTIMIZING PATIENT EXPERIENCE FOR ASYMPTOMATIC BRAIN METASTASES VIA SPECIALIZED MULTIDISCIPLINARY OUTPATIENT WORKFLOW

Abstract The diagnosis of brain metastasis is a source of clinical concern, and even asymptomatic lesions often lead to emergency room and urgent care center referrals. With the advent of multidisciplinary brain metastasis programs including outpatient triage and management pathways, we hypothesize that care can be delivered on an outpatient basis (OP), with reduced time and financial toxicity, and with equivalent efficacy to patients relative to urgent/inpatient pathways (UIP). Following development of an expedited OP Multidisciplinary Brain Metastasis pathway at an NCI-designated Comprehensive Cancer Center, we sought to quantify patient burden and clinical outcomes by referral pathway: legacy UIP vs OP. Patients referred to specialty care for asymptomatic brain metastases (aBrM) from 2019 to 2024 via UIP and OP were identified via retrospective chart review. Imaging/clinical encounters, time to brain metastasis intervention, and survival data were collected. Tumor control and radiation necrosis at 6 months were evaluated using RANO-BM. Seventy-eight patients with aBrM were identified. Forty-seven were referred to OP and 31 to UIP. Both groups had similar preoperative disease-specific graded prognostic assessments and subsequent treatments. Regression of presenting clinical characteristics against referral pathway revealed that lesion size was predictive of pathway; patients managed via UIP had larger dominant lesions (2.9cm vs 2.0cm, p =0.0009). Time to therapy was decreased via UIP management (9.2 days vs 22.2 days; p<0.0001) at the expense of increased clinical-encounter (7.1 vs 2.5; p < 0.0001) and admitted days (5.9 vs 1.1; p <0.0001), with increased mean gross charge of $51,604 ($145,659 vs $94,055; p=0.0003). Despite differential healthcare costs, 6-month survival (83% OP vs 81% UIP, p=1) and local disease control were equivalent (92% OP vs 96% UIP, p=0.48). These data support the management of selected patients with asymptomatic brain metastases with specialized outpatient care to lessen both patient burden and healthcare costs.