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Patterns of Referral for Stereotactic Radiosurgery for Patients with Brain Metastases in Alberta, Canada

2010; Elsevier BV; Volume: 78; Issue: 3 Linguagem: Inglês

10.1016/j.ijrobp.2010.07.1342

1879-355X

Bryan Brunet, C. Newcomb, Harold Lau, Peter Craighead, B. Danielson,

Advanced Radiotherapy Techniques

The Alberta Radiosurgery Centre (ARC) is located in Calgary, and is the only stereotactic radiosurgery (SRS) facility in the province of Alberta, Canada. Our study reviewed the referral patterns and characteristics of brain metastases patients referred to ARC from 2000 to 2009. Information on brain metastases patients referred for SRS was obtained from the ARC database, which captured basic demographic, referral, and treatment information on patients assessed between January 1, 2000 and August 31, 2009. Additional information was obtained by review of Electronic Medical Records to verify and complete data elements. Descriptive statistical methods were used to evaluate the data, and a geographical information program (BatchGeocode) was used to calculate distance from patient residence to ARC using postal code information and Google Maps© travel distance algorithm. Three hundred ninety-three patients accounted for 437 brain metastases referrals to ARC. The most common primary cancers, comprising 90% of referrals, were lung, breast, melanoma, renal, and colorectal. Eighty-two percent of referrals received whole brain radiotherapy as part of their treatment. Of the WBRT treatments, 71.5% were performed in Calgary, 28% in Edmonton (the only other cancer centre in Alberta with radiotherapy facilities during this time period), and 0.5% outside Alberta. The year 2000 had only 7 recorded referrals, while the first 8 months of 2009 saw 72 referrals. Between 2000 and 2008, the average yearly increase in referrals was 42%. Calgary physicians accounted for 69% of referrals, while Edmonton physicians accounted for only 29%, and 2% were from other physicians. Almost half (46%) of referred patients were from Calgary, only 15% from Edmonton, 36% from other Alberta locations, and 3% from outside Alberta. Fifty percent of patients referred lived within 25 miles of ARC. Sixty-eight percent of referrals lead to consultation, and 75% of consults resulted in treatment. Poor patient performance status was the most common reason why SRS was not performed. The ARC facility has seen a rapid progression in volumes of referrals over almost 10 years. However, most referrals are Calgary-area residents, with half of referred patients living in close proximity to ARC. As well, the majority of referrals were made by Calgary-area physicians. Increased awareness of the ARC program and referral process may improve access to SRS for brain metastases patients across Alberta.