“Choosing a treatment for brain metastases is a deeply personal decision. This tool helps to 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, an iPhone-based Cancer Decision Support Tool (CADET) was developed to help patients and their families make complex decisions using an algorithm that prioritizes their goals and values. The goal was to empower patients to drive the decision-making process and ensure that issues such as quality of life are fully considered.


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


CADET, which was developed with input and testing by patients, has successfully shown proof of principle. A manuscript will soon be published on the experience of creating this innovative tool and its clinical applicability. Future plans for CADET include further testing in the context of a multi-institution clinical trial.