Care pathways for asymptomatic brain metastases: comparison of healthcare utilization, costs, and outcomes in outpatient versus acute settings.

Authors

• Matthew Wierzbicki
• Stephen G Bowden
• Stephanie M Robert
• Seamus Y Wang
• Allison J Toth
• Brandon S Imber
• Luke R G Pike
• Viviane Tabar
• Jeffrey Groeger
• Nelson S Moss

Publication/Presentation Date

5-18-2026

Abstract

PURPOSE: Incidentally found brain metastases often lead to emergency room referrals even in asymptomatic patients-a pathway of care that could be unnecessary. We sought to compare time and financial toxicity, and treatment outcomes between a multidisciplinary outpatient (MP) and acute care pathways (AP).

METHODS: Patients referred for de novo asymptomatic brain metastases at an NCI-designated Cancer Center with a Multidisciplinary Brain Metastasis Program were identified via retrospective review. Scans, encounters, time to local interventions, and survival data were collected and compared.

RESULTS: Seventy-eight patients were identified, 47 referred to MP and 31 AP. Both groups had similar disease-specific prognostic scores and received similar treatments. Patients managed via AP had larger dominant lesions (2.9 cm vs. 2.0 cm, p <  0.002) and shorter time to therapy (13.7 days vs. 9.2 days; p = 0.047). AP patients also had more medical-encounter (7.1 vs. 2.5; p <  0.001) and admitted days (5.9 vs. 1.1; p <  0.001), with increased median gross charge amount ($185,961 vs. $126,831; p = 0.003) despite similar 6-month survival (83% MP vs. 81% AP, p > 0.999) and local tumor control (95% MP vs. 96% AP, p = 0.849).

CONCLUSION: Patients with asymptomatic brain metastases managed through an outpatient pathway attained similar disease outcomes with lower time and financial toxicity compared to patients managed through inpatient pathways. Characteristics of such patients that qualify them for outpatient pathway should be confirmed prospectively.

Volume

178

Issue

1

ISSN

1573-7373

Published In/Presented At

Wierzbicki, M., Bowden, S. G., Robert, S. M., Wang, S. Y., Toth, A. J., Imber, B. S., Pike, L. R. G., Tabar, V., Groeger, J., & Moss, N. S. (2026). Care pathways for asymptomatic brain metastases: comparison of healthcare utilization, costs, and outcomes in outpatient versus acute settings. Journal of neuro-oncology, 178(1), 5. https://doi.org/10.1007/s11060-026-05626-z

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

42151637

Department(s)

Administration and Leadership

Document Type

Article