Two decades ago, neuro-oncologist Camilo Fadul, MD, noticed key gaps in care and research for brain metastases in the United States.
"I realized these patients were not receiving the same type of coordinated and consistent care that we offered those with primary brain tumors," he says. "We lacked reliable data on incidence, patterns of care, and outcomes. And there were only a few clinical trials available to brain metastases patients."
Fadul now leads the brain metastases program at UVA Health. In this Q&A, he shares how brain metastases care is changing and what every clinician should know about treating it.
Could you further describe the needs you saw in brain metastases care?
There was an immense opportunity to transform care by examining best practices that can result in guidelines providing consistent and coordinated care to most patients, while offering hope through translational research that will improve outcomes.
One of my goals when I joined the UVA Health in 2015 was to form a healthcare group to fill the gap.
What were the goals for the UVA Health brain metastases program when it started?
The program started from the realization that there were patient needs and quality of care gaps for this patient population.
The first step was to do a needs assessment and measure indicators that would allow us to have a benchmark for processes and outcomes that could be improved.
We realized that the program needed two components:
- A clinical program of excellence that would provide coordinated and consistent care
- A research component that would congregate those doing brain metastases research at the UVA Health
Would you describe the two components as they exist today?
The clinical program of excellence started in September of 2023, and at its core is a nurse navigator/coordinator who supports the patient and referring physicians at all points of care.
Our weekly multidisciplinary clinic at UVA Cancer Center includes:
- Medical oncology
- Radiation oncology
- Neurosurgery
- Palliative care medicine
- Neuro-oncology
After the clinic, we have a multidisciplinary brain metastases conference to review complex cases and make management recommendations.
Our NCI-designated Comprehensive Cancer Center is supports the brain metastases research collaborative and covers:
- Community engagement/outreach
- Basic/translational
- Clinical trials
- Population health
- Survivorship
What's something every provider should know about brain metastases?
In the past, the standard of care for most patients with brain metastases was whole brain radiation therapy. The main complication of those who receive this therapy is long-term cognitive impairment.
Treatment options for patients with brain metastases have increased, and now only about 10-15% of patients with brain metastases would obtain any benefit from whole-brain radiation therapy.
Although most patients with brain metastases will die either from the metastatic disease or their primary cancer, we are seeing a shift with new therapeutic options in targeted systemic medical therapy. Although a few, I care for patients who are alive more than 10 years after the diagnosis of brain metastases.
In about 15% of patients with brain metastases, we have targeted therapy that does not require any form of radiation. It is crucial to identify those patients who do not need radiation to the brain, and treat them with specific therapies targeting the genomic alterations.
How do you approach working with referring providers?
Our commitment is to provide easy access to the program trying to see most patients within a week from the referral. We have nurse navigator that is available to referring providers and their patients to coordinate care.
We ensure the patient understands that their primary oncologist remains the “quarterback” for their care and we will be happy to continue participating in the patient’s care from the brain metastases perspective.