{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T07:42:49Z","timestamp":1758440569250,"version":"3.44.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":246,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The 5-factor modified frailty index (mFI-5) has been increasingly studied in the context of patients with central nervous system tumors. Previously, studies have demonstrated an inverse relationship between increasing mFI-5 scores and overall\/progression-free survival in patients with brain metastases (BMs) undergoing stereotactic radiosurgery (SRS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A single payer insurance database was queried for patients undergoing SRS for BMs. Patients were stratified based on mFI-5 scores as follows: pre-frail (0-1), frail (2), and severely frail (\u2265\u20053). Survival trends and healthcare utilization rates following treatment were analyzed across each frailty group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 9927 patients were retrospectively analyzed. Overall survival (OS) was significantly decreased in the frail and severely frail groups compared to pre-frail patients (frail: HR: 1.55, 95% CI: 1.33\u20131.80, P\u2005&amp;lt;\u2005.0001) and (severely frail: HR: 2.12, 95% CI: 1.84\u20132.44, P\u2005&amp;lt;\u2005.0001). Increased healthcare utilization was observed after SRS in frail and severely frail patients (frail: 90-day RR 1.07, 180-day RR 1.08. and 1-year RR 1.10, P\u2005&amp;lt;\u2005.0001; severely frail: 90-day RR 1.16, 180-day RR 1.18, 1-year RR 1.21, P\u2005&amp;lt;\u2005.0001). In patients with established palliative care involvement at the time of SRS, healthcare utilization rates were decreased in the frail and severely frail groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Increasing frailty scores portended reduced OS with increased overall healthcare utilization rates. The introduction of palliative care prior to SRS decreased healthcare utilization rates across frailty cohorts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/noajnl\/vdaf186","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T11:26:05Z","timestamp":1756725965000},"source":"Crossref","is-referenced-by-count":0,"title":["The role of palliative care at the time of stereotactic radiosurgery on healthcare utilization for frail patients with brain metastases"],"prefix":"10.1093","volume":"7","author":[{"given":"Trent","family":"Kite","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network Neuroscience Institute , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teigan","family":"Dwyer","sequence":"additional","affiliation":[{"name":"Enterprise Analytics, Highmark Health , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5084-3127","authenticated-orcid":false,"given":"Charlotte","family":"Drury-Gworek","sequence":"additional","affiliation":[{"name":"Enterprise Analytics, Highmark Health , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyson","family":"Barrett","sequence":"additional","affiliation":[{"name":"Enterprise Analytics, Highmark Health , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Herbst","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network Neuroscience Institute , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Ombres","sequence":"additional","affiliation":[{"name":"Highmark Health , Pittsburgh, PA ,","place":["USA"]},{"name":"Division of Supportive Care, Allegheny Health Network Cancer Institute , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah","family":"Herbst","sequence":"additional","affiliation":[{"name":"Division of Supportive Care, Allegheny Health Network Cancer Institute , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Karlovits","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Allegheny Health Network Cancer Institute , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodney E","family":"Wegner","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Allegheny Health Network Cancer Institute , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J","family":"Shepard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network Neuroscience Institute , Pittsburgh, PA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"issue":"2","key":"2025091922071969300_CIT0001","doi-asserted-by":"crossref","first-page":"110979","DOI":"10.1016\/j.jocn.2024.110979","article-title":"The 5-factor modified frailty index as a prognostic factor following stereotactic radiosurgery for metastatic disease to the brain from non-small cell lung cancer: a multi-center cohort analysis","volume":"132","author":"Rajkumar","year":"2025","journal-title":"J Clin Neurosci."},{"issue":"4","key":"2025091922071969300_CIT0002","doi-asserted-by":"crossref","first-page":"929","DOI":"10.3171\/2023.7.JNS231214","article-title":"The 5-factor modified frailty index as a prognostic factor of stereotactic radiosurgery for metastatic disease to the brain","volume":"140","author":"Lucido","year":"2024","journal-title":"J 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