Survival and treatment among older patients with brain metastases: a population-based study

BACKGROUND: Generalizable, large-scale data describing outcomes and treatment approaches for older adults with brain metastases remain limited. In this investigation, we evaluated prognosis and patterns of care in this population over time, with particular attention to the potential impact of social determinants of health. METHODS: We used the Surveillance, Epidemiology, and End Results-Medicare database to delineate survival, treatment patterns, and disparities among patients aged 65 years and older with brain metastases diagnosed between 2010 and 2020. Survival was assessed with Kaplan-Meier methods and multivariable Cox regression. RESULTS: This study included 67 832 patients (51% female). The median survival from diagnosis of brain metastases was 3.42 months, improving modestly from 2.99 months in 2010 to 3.88 months in 2019. Higher zip-code level annual income (hazard ratio [HR] = 0.98 per $10 000 increase, 95% confidence interval [CI] = 0.97 to 0.98; P < .001) and higher rates of zip-code level high school graduation (HR = 0.98 per 10% increase, 95% CI = 0.97 to 0.99; P = .001) were associated with lower mortality. Among patients managed with brain-directed radiation, 62% and 38% received nonstereotactic (inclusive of whole brain radiation) and stereotactic approaches, respectively. Use of stereotactic radiation increased from 22% in 2010 to 54% in 2019. Compared with White patients, Black patients (HR = 0.79, 95% CI = 0.73 to 0.86; P < .001) and Hispanic patients (HR = 0.87, 95% CI = 0.79 to 0.95; P = .002) were less likely to receive stereotactic radiation. CONCLUSIONS: The prognosis among older patients with brain metastases remains poor. Many patients continue to receive nonstereotactic approaches. Further work to improve the prognosis of older patients with brain metastases and optimize patterns of care is needed.