Medical Student Rosalind Franklin University Medical School Chicago, Illinois, United States
Disclosure(s):
Pranav Mirpuri: No financial relationships to disclose
Introduction: Knowledge of patient and tumor specific biomarkers has not significantly improved outcome for patients with glioblastoma. The contribution of social factors to prognosis remains understudied. Using the Area Deprivation Index, a composite of 17 socioeconomic metrics, we asked if the circumstances in which a glioblastoma patient works, and lives are associated with outcome. In addition, we explored the influence of neighborhood disadvantage on access to standard of care chemoradiation for glioblastoma patients treated in a large, multistate health care system.
Methods: This is a retrospective review of patients with newly diagnosed glioblastoma undergoing surgery between 2015 and 2020. In addition to usual demographic and tumor specific data, we determined the National Area Deprivation Index for each patient.
Results: There were 244 glioblastoma patients. Patients living in the most deprived neighborhoods had a significantly shorter median survival compared to those living in the least deprived neighborhoods: 210 days (95% CI 134–334) versus 384 days (95% CI 239–484), p = 0.017, log-rank test. Patients who received chemoradiation had a significantly longer median survival (424 days, 95% CI 355-468) compared to patients who did not (56 days, 95% CI 36-83), p = 0.0000, logrank test. One quarter of patients living in the most disadvantaged neighborhoods, 20% of Black and one third of Hispanic patients did not receive standard of care chemoradiation.
Conclusion : Patients with newly diagnosed glioblastoma residing in the most disadvantaged neighborhoods had a significantly shorter median survival compared to those living in affluence. Unexpectedly, we found that neighborhood disadvantage and race predicted receipt of standard of care treatment. Patients who received chemoradiation had a 12-month longer median survival than those who did not. Our findings are both timely and salient- neurosurgeons must advocate for equitable access to treatment to ensure the best outcomes for their patients.
