Please select the option that best describes you:
Do you refer all patients with new findings of CNS or epidural mets/tumor to ED for evaluation or are there some that can be managed completely outpatient?
E.g., patients with small CNS mets without vasogenic edema or symptoms. Epidural disease without epidural spinal cord compression or asymptomatic low-grade ESCC. Reflexively referring to ED can be erode trust if they are not receiving much care in ED or inpatient. Also, question the role of empiric steroids and AEDs in these cases.
Answer from: at Academic Institution
I think that a decision to refer to the ER depends on the patient's symptoms, the size/type of CNS lesion, and your practice setting. Small asymptomatic or incidentally discovered brain metastases may not require management in an ER or inpatient setting. Leptomeningeal disease, by comparison, is som...
Answer from: Radiation Oncologist at Academic Institution
Agree with the comments above and Dr. @Marks' concerns regarding not only the broader implications of ED overuse but also the long wait times and poor experiences generally experienced by cancer patients.I will add that one commonly encountered issue that can result in the inappropriate escalation o...
Answer from: Radiation Oncologist at Community Practice
I would bet that most rad oncs do NOT routinely send people with brain mets to the ER. It would be an interesting poll question.
Answer from: at Academic Institution
If the patient has no impending neurologic emergency, we manage as an outpatient with steroids and radiation. Why send to ED where the doctors are busy with trauma and patients are likely to be exposed to COVID-19? If there's impending cord compression then admit and treat inpatient.
I virtually always manage asymptomatic patients as...