Distance traveled to glioblastoma treatment: A measure of the impact of socioeconomic status on survival

https://doi.org/10.1016/j.clineuro.2021.106909Get rights and content

Highlights

  • Patients who travel long distances to glioblastoma treatment have better survival.

  • Adjusting for income eliminates the relationship between distance and survival.

  • Socioeconomic status is more important than distance for glioblastoma survival.

Abstract

Background

Previous studies have shown improved post-surgical outcomes in patients who travel farther for glioblastoma treatment. This study investigates socioeconomic and facility factors that may influence this relationship.

Methods

Overall survival was calculated and compared by distance to treatment facility using univariate and multivariate survival models. The analysis was stratified by facility type, income quartile and insurance status and the association re-evaluated. Kaplan-Meier survival curves were created to analyze the relationship between overall survival and distance group.

Results

Individuals who traveled less than 5 miles to treatment had the shortest overall survival (11.8 months), while those who traveled greater than 50 miles had the longest survival (12.9 months). Stratification by income quartile failed to demonstrate an association between distance traveled and survival for those making less than $63,000 (adjusted hazard ratio range: 0.94–1.01). There was no association between survival and distance traveled for patients treated at a community cancer center, comprehensive community cancer center or an integrated network cancer program (adjusted hazard ratio range: 0.86–1.04).

Conclusion

Financial strain, rather than distance traveled to treatment, may be associated with glioblastoma 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.

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