Distance traveled to glioblastoma treatment: A measure of the impact of socioeconomic status on survival
Introduction
Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor with an incidence of 3.19 per 100,000 people in the United States [1]. For patients with GBM there is a need for comprehensive interdisciplinary care and coordination for treatment and best outcomes [2], [3]. However, there are disparities in accessing multidisciplinary treatment. Previous studies have shown correlations between distance traveled and outcomes in patients undergoing surgical resection of glioblastoma, but secondary factors that influence this correlation have not been identified. This study investigates the role of socioeconomic status on the relationship between overall survival and distance traveled to treatment in patients with GBM.
Section snippets
Cohort selection
Adults with GBM diagnosed between 2008 through 2017 were identified from the National Cancer Database (NCDB). The NCDB is a joint project of the American Cancer Society and the Commission on Cancer of the American College of Surgeons. The data used in this study are derived from de-identified NCDB data [4]. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from
Cohort description
The study cohort consisted of 57,783 individuals with a mean age of 62 years. Most patients were males (59%), lived in metropolitan areas (81%), and were white non-Hispanic (82%). A majority of patients had either private insurance or Medicare for medical coverage at the time of diagnosis (85%). Those who traveled less than 5 miles to treatment facility had the largest minority population (24%) (Table 1).
Multiple logistic regression model
Patients treated at academic and integrated network cancer programs and those with a higher
Discussion
In this study we queried a nationwide cohort of individuals diagnosed with GBM and assessed the impact of socioeconomic and facility factors on the relationship between travel distance to treatment and survival outcomes. Our study demonstrates that when adjusted for income, individuals who travel shorter distances have similar survival outcomes compared to those who travel farther distances for treatment. In addition, we found increased overall survival for patients who had treatment at
Conclusion
Difficulty financing travel limits the access patients have to multimodal treatment. Patients who travel from farther distances to treatment facilities have better overall survival in our analysis, but this association is extinguished when accounting for income. This suggests that financial strain, instead of travel burden, is an important driving factor in patients being treated for glioblastoma. As income is used as a proxy for socioeconomic findings, this study describes the importance of
Funding
This research was supported by the Eugene P. Frenkel, M.D. Award Program and The University of Texas Southwestern Medical Center -Dallas Physician-Scientist Institutional Award from the Burroughs Wellcome Fund.
CRediT authorship contribution statement
Cylaina E. Bird: Methodology, Validation, Formal Analysis, Data Curation, Writing – original draft, Writing – review & editing. Jeffrey Traylor: Writing – review & editing. Michael Youssef: Writing – review & editing. Kalil Abdullah: Conceptualization, Writing – original draft, Writing – review & editing.
Conflicts of Interest
The authors have no conflicts, material or otherwise, to disclose.
References (24)
- et al.
Editorial on brain tumor patients, their health insurance and personal bankruptcy
NeuroImage
(2011) - et al.
Epidemiology and Outcome of Glioblastoma
- et al.
The impact of traveling distance and hospital volume on post-surgical outcomes for patients with glioblastoma
J. Neurooncol.
(2019) - et al.
Glioma incidence and survival variations by county-level socioeconomic measures
Cancer
(2019) - et al.
Incident cases captured in the National Cancer Database compared with those in U.S. population based central cancer registries in 2012–2014
Ann. Surg. Oncol.
(2019) - et al.
How far Americans live from the closest hospital differs by community type
Pew Res. Cent.
(2018) - et al.
Distance traveled to head and neck cancer provider: a measure of socioeconomic status and access
Otolaryngol. Head. Neck Surg.
(2020) - et al.
Glioblastoma--the consequences of advanced patient age on treatment and survival
Neurosurg. Rev.
(2007) - et al.
Disparities in receipt of modern concurrent chemoradiotherapy in glioblastoma
J. Neuro Oncol.
(2016) - et al.
Age alone is not a predictor for survival in glioblastoma
J. Neurooncol.
(2016)
Racial/ethnic differences in survival among elderly patients with a primary glioblastoma
J. Neurooncol.
Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma
J. Neurosurg. JNS
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