Medical Student Loyola University Chicago Stritch School of Medicine
Introduction: Not all patients affected by GBM undergo longitudinal treatment following primary surgical resection. Previous studies suggest that socioeconomic factors have been demonstrated to play a role in the receipt of appropriate GBM treatment, yet factors associated with the declination of surgery or radiotherapy by patients with GBM have not been studied.
Methods: We queried the National Cancer Database (NCDB) from 2004 to 2018 to identify patients presenting with GBM who either received surgical resection and radiotherapy or rejected a physician’s recommendation to undergo treatment. Multivariable regression (MVR) modeling was used to identify factors associated with rejecting surgical resection or radiotherapy. Patients receiving GBM treatment were 3:1 propensity score matched to those rejecting treatment and median overall survival (OS) was compared.
Results: 91,388 patients met our inclusion criteria. 90,258 (98.8%) received surgical resection, and 1,130 (1.2%) rejected surgical treatment. 67,169 (96.8%) received surgical resection and radiotherapy, and 2,248 (3.2%) received surgical resection but refused radiotherapy. On MVR, factors independently associated with refusal of surgery included: 63+ years of age, Medicaid or uninsured status, females, Black patients, Southern geographic region, and living 55+ miles away from a treatment facility (all values p< 0.05). On MVR, factors independently associated with refusal of radiotherapy included: 63+ years of age, Medicaid or uninsured status, females, Charlson-Deyo Index of 1+, Midwest geographic region, and living 55+ miles away from the treatment facility (all values p< 0.05). On propensity-matched analysis, refusal of surgery conferred a 4-month decrease in OS (p < 0.001) and refusal of radiotherapy conferred an 8-month decrease in OS (p < 0.001).
Conclusion : In patients presenting with GBM, older age, female sex, Medicaid and uninsured status, farther distance from the treatment facility, and region of the country were associated with the refusal of surgery and the refusal of post-surgical radiotherapy.
