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Purpose <p>The diagnosis and treatment of brain metastases (BMs) pose significant challenges to patients, their caregivers, and physicians. Stereotactic radiosurgery (SRS) is a primary or adjuvant approach for the treatment of BMs but underlying socioeconomic factors may delay access to SRS and subsequent follow-up care.</p> Methods <p>This is a retrospective study of patients with brain metastases who underwent Gamma Knife<sup>®</sup> (GK) SRS as their primary treatment modality from 2012 to 2023 at a multi-hospital health system with a safety net hospital through a centralized workflow for referrals. Time from first BM diagnosis to initial SRS was analyzed across patient demographics, median household income based on U.S. Census Bureau 5-year estimates, insurance carrier, and public versus private referring hospital. Survival analyses were conducted using the Kaplan-Meier method.</p> Results <p>1216 patients with 4576 brain metastases were included in the analysis. The median time from diagnosis of BM to SRS was 15 days. Patients referred from the public hospital had increased time to SRS (25 days) compared to the private hospital (14 days, <i>p</i> &lt; 0.001) and were more likely to be lost to follow-up (21% vs. 5%, <i>p</i> &lt; 0.001). There was no difference in overall survival between any groups for patients that received SRS.</p> Conclusion <p>Systemic institutional and socioeconomic barriers affect timely SRS delivery following newly diagnosed BMs. Through a centralized workflow in in coordinating complex oncologic care in a multi-hospital network, increased time to receive SRS did not translate into measurable survival disparities.</p>

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Evaluation of disparities in timely stereotactic radiosurgery for brain metastases in a safety net hospital system through a centralized workflow

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Brandon A. Santhumayor,
  • Jason D. Domogauer,
  • Kenneth Bernstein,
  • Bernadine Donahue,
  • Ying Meng,
  • David Kurland,
  • Jason Gurewitz,
  • Benjamin Cooper,
  • Douglas Kondziolka

摘要

Purpose

The diagnosis and treatment of brain metastases (BMs) pose significant challenges to patients, their caregivers, and physicians. Stereotactic radiosurgery (SRS) is a primary or adjuvant approach for the treatment of BMs but underlying socioeconomic factors may delay access to SRS and subsequent follow-up care.

Methods

This is a retrospective study of patients with brain metastases who underwent Gamma Knife® (GK) SRS as their primary treatment modality from 2012 to 2023 at a multi-hospital health system with a safety net hospital through a centralized workflow for referrals. Time from first BM diagnosis to initial SRS was analyzed across patient demographics, median household income based on U.S. Census Bureau 5-year estimates, insurance carrier, and public versus private referring hospital. Survival analyses were conducted using the Kaplan-Meier method.

Results

1216 patients with 4576 brain metastases were included in the analysis. The median time from diagnosis of BM to SRS was 15 days. Patients referred from the public hospital had increased time to SRS (25 days) compared to the private hospital (14 days, p < 0.001) and were more likely to be lost to follow-up (21% vs. 5%, p < 0.001). There was no difference in overall survival between any groups for patients that received SRS.

Conclusion

Systemic institutional and socioeconomic barriers affect timely SRS delivery following newly diagnosed BMs. Through a centralized workflow in in coordinating complex oncologic care in a multi-hospital network, increased time to receive SRS did not translate into measurable survival disparities.