???Choosing a treatment for brain metastases is a deeply personal decision. This tool will help illustrate which strategy best fits with the patient???s values and goals and thus facilitates an informed discussion about treatment options between patients and their doctors.??? - Malolan S. Rajagopalan, MD, Radiation Oncology, UPMC Shadyside


Grant Application

Sushil Beriwal, MD, Radiation Oncology, UPMC Shadyside, UPMC CancerCenter


Proposed Innovation

Approximately 15 percent of all cancer patients develop brain metastases or spread of cancer cells from elsewhere in the body to the brain. Patients with brain metastases face difficult decisions regarding treatment options as they grapple with end-of-life issues. Although several treatment options are available, they vary greatly in terms of aggressiveness, side effects, symptom control, required hospital visits, outcome, and cost.

Through this innovative project, a web-based Cancer Decision Support Tool (CADET) will be developed to support patients and their families in making complex decisions using an algorithm that prioritizes their goals and values. It will empower patients to drive the decision-making process and ensure that issues such as quality of life are fully considered.


Improvements in Action

Options for patients with multiple brain metastases include stereotactic radiosurgery (SRS), whole brain radiation therapy (WBRT), and supportive care. Through the CADET technology, patients will answer questions designed to identify their values, goals of care, and tradeoffs in toxicities they are willing to accept. Scores generated from the CADET algorithm will indicate which treatment is favored and serve as a starting point in discussing treatment options with physicians.


Results – In Progress

CADET will be developed in four phases over the course of 12 to 16 months with input and testing by patients. A pilot test will be conducted in the final phase. The model will be accessible through a web-based portal as well as with smartphones and tablets. Use of the tool also may be expanded to all cancer patients.