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Baqri W, Rzadki K, Habbous S, Das S. Treatment, healthcare utilization and outcomes in patients with glioblastoma in Ontario: a 10-year cohort study. J Neurooncol 2024; 168:473-485. [PMID: 38702569 DOI: 10.1007/s11060-024-04690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE Glioblastoma (GBM) is the most common malignant primary brain tumour in adults. Receipt of adjuvant therapies has been shown to exert a significant positive effect on patient survival. Little is known however about how changes in standards of care and healthcare system factors, such as access, affect real-world outcomes. In this study, we provide an overview of GBM in Ontario and examine elements of care, including treatment patterns, healthcare utilization, and overall survival, from 2010 to 2019, to interpret the impact of the changes in practice standards and expansion of the care network within this period. METHODS Using linked health-administrative databases from Ontario, Canada, we conducted a population-based cohort study to examine the clinical and biological characteristics, treatment, and healthcare utilization patterns of adult GBM patients diagnosed between 2010 and 2019. The primary outcomes were enrollment in adjuvant chemoradiation treatment and 1-, 2-, and 5-year survival. All analyses were performed using the Statistical Analysis Software (SAS). RESULTS 5392 patients were diagnosed with GBM in Ontario from 2010 to 2019 (58% male, 42% female). The median age at diagnosis was 64. Receipt of adjuvant chemoradiation within one year of diagnosis increased from 51% in 2010 to 63% in 2019. 1-year, 2-year, and 5-year overall survival for all patients remained stable, ranging between 40 and 43%, 15-19%, and 5-7%, respectively. For patients above the age of 65, however, 1-year survival increased from 19% in 2010 to 26% in 2019. INTERPRETATION Regionalization enabled access to treatment closer to home for many patients. Over the last decade, receipt of adjuvant chemoradiation increased among elderly patients, but the improvement in 1-year overall survival over time was accounted for by sociodemographic and clinical covariates. Our findings support the efforts for regionalization of services to improve accessibility. CONCLUSION This Ontario-based study provides insight into the effect of practice evolution and healthcare utilization on the overall survival of patients with GBM. Overall survival for most patients with glioblastoma has remained stagnant over the past decade. Changes in treatment standards and expansion of access to treating centres have been associated with prolonged survival in elderly glioblastoma patients.
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Affiliation(s)
- Wafa Baqri
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn Rzadki
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
- Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Sunit Das
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada.
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Nguyen AV, Soto JM, Digbeu BD, Nguyen CY, Wu E, Huang JH, Kuo YF. Factors associated with longer survival among older medicare patients after diagnosis of supratentorial primary brain malignancies: a retrospective cohort study. Neurol Res 2024; 46:379-390. [PMID: 38415699 DOI: 10.1080/01616412.2024.2323335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Despite recent advances, the prognosis for primary malignant brain tumors (PMBTs) remains poor. Some commonly prescribed medications may exhibit anti-tumor properties in various cancers, and neurodegenerative diseases may activate pathways that counteract gliomagenesis. Our study is focused on determining if there is a correlation between the use of metformin, beta-blockers, angiotensin converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs), or the presence of Parkinson's disease (PD), and the survival rates following a diagnosis of a PMBT. METHODS This analysis of the 100% Texas Medicare Database identified patients aged 66+ years diagnosed with a supratentorial PMBT from 2014-2017. Cox proportional hazards regression was employed to analyze survival following diagnosis and associations of survival with surgical intervention, radiation, PD diagnosis, and prescription of metformin, beta-blockers, ACEIs, or ARBs. RESULTS There were 1,943 patients who met study criteria, and the median age was 74 years. When medication utilization was stratified by none, pre-diagnosis only, post-diagnosis only, or both pre- and post-diagnosis (continuous), continuous utilization of metformin, beta-blockers, ACEIs, or ARBs was associated with prolonged survival compared to no utilization (hazard ratio [HR]:0.45, 95% CI:0.33-0.62; HR:0.71. 95% CI:0.59-0.86; HR:0.59, 95% CI:0.48-0.72; and HR:0.45, 95% CI:0.35-0.58 respectively). PD was also associated with longer survival (HR:0.59-0.63 across the four models). DISCUSSION Our study suggests that metformin, beta-blockers, ACEIs, ARBs, and comorbid PD are associated with a survival benefit among geriatric Medicare patients with supratentorial PMBTs.
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Affiliation(s)
- Anthony V Nguyen
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, USA
| | - Jose M Soto
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, USA
| | - Biai D Digbeu
- Department of Biostatistics and Data Science, Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Christine Y Nguyen
- Department of Internal Medicine, Baylor Scott & White Health, Scott and White Medical Center, Temple, TX, USA
| | - Erxi Wu
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, USA
- Department of Surgery, Texas A&M University School of Medicine, Temple, TX, USA
- Department of Neurosurgery, Baylor College of Medicine, Temple, TX, USA
- Department of Pharmaceutical Sciences, Texas A&M University School of Pharmacy, College Station, TX, USA
- LIVESTRONG Cancer Institutes and Department of Oncology, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, USA
- Department of Surgery, Texas A&M University School of Medicine, Temple, TX, USA
- Department of Neurosurgery, Baylor College of Medicine, Temple, TX, USA
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
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Pugazenthi S, Price M, De La Vega Gomar R, Kruchko C, Waite KA, Barnholtz-Sloan JS, Walsh KM, Kim AH, Ostrom QT. Association of county-level socioeconomic status with meningioma incidence and outcomes. Neuro Oncol 2024; 26:749-763. [PMID: 38087980 PMCID: PMC10995507 DOI: 10.1093/neuonc/noad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Prior literature suggests that individual socioeconomic status (SES) may influence incidence, treatments, and survival of brain tumor cases. We aim to conduct the first national study to evaluate the association between US county-level SES and incidence, treatment, and survival in meningioma. METHODS The Central Brain Tumor Registry of the United States analytic dataset, which combines data from CDC's National Program of Cancer Registries (NPCR) and National Cancer Institute's Surveillance, Epidemiology, and End Results Program, was used to identify meningioma cases from 2006 to 2019. SES quintiles were created using American Community Survey data. Logistic regression models were used to evaluate associations between SES and meningioma. Cox proportional hazard models were constructed to assess the effect of SES on survival using the NPCR analytic dataset. RESULTS A total of 409 681 meningioma cases were identified. Meningioma incidence increased with higher county-level SES with Q5 (highest quintile) having a 12% higher incidence than Q1 (incidence rate ratios (IRR) = 1.12, 95%CI: 1.10-1.14; P < .0001). The Hispanic group was the only racial-ethnic group that had lower SES associated with increased meningioma incidence (Q5: age-adjusted incidence ratio (AAIR) = 9.02, 95%CI: 8.87-9.17 vs. Q1: AAIR = 9.33, 95%CI: 9.08-9.59; IRR = 0.97, 95%CI: 0.94-1.00; P = .0409). Increased likelihood of surgical treatment was associated with Asian or Pacific Islander non-Hispanic individuals (compared to White non-Hispanic (WNH)) (OR = 1.28, 95%CI: 1.23-1.33, P < .001) and males (OR = 1.31, 95%CI: 1.29-1.33, P < .001). Black non-Hispanic individuals (OR = 0.90, 95%CI: 0.88-0.92, P < .001) and those residing in metropolitan areas (OR = 0.96, 95%CI: 0.96-0.96, P < .001) were less likely to receive surgical treatment compared to WNH individuals. Overall median survival was 137 months, and survival was higher in higher SES counties (Q5 median survival = 142 months). CONCLUSIONS Higher county-level SES was associated with increased meningioma incidence, surgical treatment, and overall survival. Racial-ethnic stratification identified potential disparities within the meningioma population. Further work is needed to understand the underpinnings of socioeconomic and racial disparities for meningioma patients.
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Affiliation(s)
- Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
| | - Kyle M Walsh
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
- The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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Ghanem M, Ghaith AK, Zamanian C, Bon-Nieves A, Bhandarkar A, Bydon M, Quiñones-Hinojosa A. Deep Learning Approaches for Glioblastoma Prognosis in Resource-Limited Settings: A Study Using Basic Patient Demographic, Clinical, and Surgical Inputs. World Neurosurg 2023; 175:e1089-e1109. [PMID: 37088416 DOI: 10.1016/j.wneu.2023.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common brain tumor in the United States, with an annual incidence rate of 3.21 per 100,000. It is the most aggressive type of diffuse glioma and has a median survival of months after treatment. This study aims to assess the accuracy of different novel deep learning models trained on a set of simple clinical, demographic, and surgical variables to assist in clinical practice, even in areas with constrained health care infrastructure. METHODS Our study included 37,095 patients with GBM from the SEER (Surveillance Epidemiology and End Results) database. All predictors were based on demographic, clinicopathologic, and treatment information of the cases. Our outcomes of interest were months of survival and vital status. Concordance index (C-index) and integrated Brier scores (IBS) were used to evaluate the performance of the models. RESULTS The patient characteristics and the statistical analyses were consistent with the epidemiologic literature. The models C-index and IBS ranged from 0.6743 to 0.6918 and from 0.0934 to 0.1034, respectively. Probabilistic matrix factorization (0.6918), multitask logistic regression (0.6916), and logistic hazard (0.6916) had the highest C-index scores. The models with the lowest IBS were the probabilistic matrix factorization (0.0934), multitask logistic regression (0.0935), and logistic hazard (0.0936). These models had an accuracy (1-IBS) of 90.66%; 90.65%, and 90.64%, respectively. The deep learning algorithms were deployed on an interactive Web-based tool for practical use available via https://glioblastoma-survanalysis.herokuapp.com/. CONCLUSIONS Novel deep learning algorithms can better predict GBM prognosis than do baseline methods and can lead to more personalized patient care regardless of extensive electronic health record availability.
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Affiliation(s)
- Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cameron Zamanian
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Antonio Bon-Nieves
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Archis Bhandarkar
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Gorenflo MP, Shen A, Murphy ES, Cullen J, Yu JS. Area-level socioeconomic status is positively correlated with glioblastoma incidence and prognosis in the United States. Front Oncol 2023; 13:1110473. [PMID: 37007113 PMCID: PMC10064132 DOI: 10.3389/fonc.2023.1110473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
In the United States, an individual’s access to resources, insurance status, and wealth are critical social determinants that affect both the risk and outcomes of many diseases. One disease for which the correlation with socioeconomic status (SES) is less well-characterized is glioblastoma (GBM), a devastating brain malignancy. The aim of this study was to review the current literature characterizing the relationship between area-level SES and both GBM incidence and prognosis in the United States. A query of multiple databases was performed to identify the existing data on SES and GBM incidence or prognosis. Papers were filtered by relevant terms and topics. A narrative review was then constructed to summarize the current body of knowledge on this topic. We obtained a total of three papers that analyze SES and GBM incidence, which all report a positive correlation between area-level SES and GBM incidence. In addition, we found 14 papers that focus on SES and GBM prognosis, either overall survival or GBM-specific survival. Those studies that analyze data from greater than 1,530 patients report a positive correlation between area-level SES and individual prognosis, while those with smaller study populations report no significant relationship. Our report underlines the strong association between SES and GBM incidence and highlights the need for large study populations to assess SES and GBM prognosis to ideally guide interventions that improve outcomes. Further studies are needed to determine underlying socio-economic stresses on GBM risk and outcomes to identify opportunities for intervention.
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Affiliation(s)
- Maria P. Gorenflo
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Alan Shen
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Erin S. Murphy
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Jennifer S. Yu
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
- *Correspondence: Jennifer S. Yu,
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The Association of Preoperative Frailty and Neighborhood-Level Disadvantage with Outcome in Patients with Newly Diagnosed High Grade Glioma. World Neurosurg 2022; 166:e949-e957. [PMID: 35948225 DOI: 10.1016/j.wneu.2022.07.138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Individual patient and socioeconomic factors are underexplored prognostic factors for glioblastoma (GBM). Frailty, a measure of physiological vulnerability, and area deprivation, a measure of socioeconomic status, are easily obtained during the preoperative evaluation. These metrics are predictors of outcome and access to treatments for other cancers. Therefore, we sought to determine the association of frailty and neighborhood disadvantage with outcomes of patients with newly diagnosed GBM. METHODS This was a retrospective review of newly diagnosed patients with GBM undergoing surgery from 2015 through 2020. The 5-factor modified frailty index and national area deprivation index were determined for each patient. RESULTS There were 244 patients. Compared with patients with "some or no" frailty, patients with "significant" frailty had a shorter median survival: 273 days (95% confidence interval [CI] 126-339) versus 393 days (95% CI 317-458), P = 0.008. The median survival for patients living in the most disadvantaged neighborhoods, 210 days (95% CI 134-334), was significantly lower than for those living in the least, 384 days (95% CI 239-484), P = 0.17. Twenty-five percent of patients living in the most disadvantaged neighborhoods did not receive postoperative chemoradiation compared with 11% of patients in the least disadvantaged neighborhoods, P = 0.046. Similarly, patients of color were less likely to receive standard of care chemoradiation than White patients. CONCLUSIONS Increasing frailty and neighborhood disadvantage predict worse outcomes in newly diagnosed patients with GBM undergoing surgery. Patients living in the most-deprived neighborhoods are less likely to receive postoperative chemoradiation. Identification of nontraditional predictors of treatment access and survival will inform mitigation strategies and improve outcomes.
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Lee JH, Cho Y, Kim YJ, Cho YH, Jeong YH, Jang HJ, Ro SK, Kim H. Impact of Individual Income Level on Late Mortality After Coronary Artery Bypass Grafting. Ann Thorac Surg 2022; 114:1327-1333. [PMID: 35305990 DOI: 10.1016/j.athoracsur.2022.02.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 11/01/2022]
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Alexopoulos G, Zhang J, Karampelas I, Patel M, Kemp J, Coppens J, Mattei TA, Mercier P. Long-term time series forecasting and updates on survival analysis of glioblastoma multiforme, a 1975-2018 population-based study. Neuroepidemiology 2022; 56:75-89. [PMID: 35172317 DOI: 10.1159/000522611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Glioblastomas(GBM) are the most common primary CNS tumors. Epidemiologic studies have investigated the effect of demographics on patient survival, but the literature remains inconclusive. METHODS This study included all adult patients with intracranial GBMs reported in the SEER-9 population database (1975-2018). The sample consisted of 32746 unique entries. We forecast the annual GBM incidence in the US population through the year of 2060 using time series analysis with autoregressive moving averages. A survival analysis of the GBM-specific time to death was also performed. Multivariate Cox Proportional Hazards(PH) regression revealed frank violations of the PH assumption for multiple covariates. Parametric models best described the GBM population's survival pattern; the results were compared to the semi-parametric analysis and the published literature. RESULTS We predicted an increasing GBM incidence, which demonstrated that by the year 2060, over 1800 cases will be reported annually in the SEER. All eight demographic variables were significant in the univariable analysis. The calendar year 2005 was the cutoff associated with an increased survival probability. A male survival benefit was eliminated in the year-adjusted Cox. The factors: infratentorial tumors, non-metropolitan areas, and White patient race were erroneously associated with survival in the multivariate Cox analysis. AFT lognormal regression was the best model to describe the survival pattern in our patient population, identifying age > 30 years old as a poor prognostic and patients > 70 years old as having the worst survival. Annual income > $75,000 and supratentorial tumors were good prognostics, while surgical intervention provided the strongest survival benefit. CONCLUSIONS Annual GBM incidence rates will continue to increase by almost 50% in the upcoming 30 years. Cox regression analysis should not be utilized for time-to-event predictions in GBM survival statistics. AFT lognormal distribution best describes the GBM specific survival pattern, and as an inherent population characteristic, it should be implemented by researchers for future studies. Surgical intervention provides the strongest survival benefit, while patient age > 70 years old is the worst prognostic. Based on our study, the demographics: gender, race, and county type should not be considered as meaningful prognostics when designing future trials.
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Affiliation(s)
- Georgios Alexopoulos
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Justin Zhang
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Ioannis Karampelas
- Department of Neurosurgery, Banner Neurological Surgery Clinic, Greeley, Colorado, USA
| | - Mayur Patel
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Joanna Kemp
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Tobias A Mattei
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Philippe Mercier
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
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Hong MAC, Omar AT, Khu KJO. Socioeconomic factors affecting survivorship of glioblastoma patients in the Philippines. J Clin Neurosci 2022; 98:89-95. [PMID: 35151062 DOI: 10.1016/j.jocn.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022]
Abstract
Glioblastoma (GBM) is the most common malignant primary brain tumor in adults worldwide. However, data on the survivorship of GBM patients in low- and middle-income countries is sparse. We determined whether socioeconomic factors such as marital status, place of residence, educational attainment, employment status, and income affected survival. A retrospective cohort study of surgically managed GBM patients (n = 48) in a single center over a five-year period was conducted using chart review and telephone interview. The mean age was 41 years, with a male predilection (62%). Most patients were married (73%), employed full time (79%), resided in a rural location (56%), completed secondary education (44%), and had a low income (83%). Most of the tumors were > 5 cm at the time of diagnosis (90%) and involved more than one lobe (40%). Majority underwent subtotal resection (56%). Only 15% (n = 7) had adjuvant chemoradiation while 23% (n = 11) had radiotherapy alone. Median overall survival was 7.6 months. Multivariate analysis showed that extent of resection (gross total resection, p = 0.0033; subtotal resection, p = 0.0069) and adjuvant treatment (p = 0.0254) were associated with improved survival, while low income (p = 0.0178) and educational (p = 0.0206) levels and part-time employment (p = 0.0063) were associated with decreased survival. Many GBM patients at our center presented at an advanced stage in their natural history, and majority (62%) did not receive adjuvant treatment after surgery. As such, the median overall survival was less than that reported in developed countries. Of the socioeconomic factors analyzed, low income and educational levels and part-time employment were negatively associated with survivorship.
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Affiliation(s)
- Manilyn Ann C Hong
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines
| | - Abdelsimar T Omar
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
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Systematic Review of Racial, Socioeconomic, and Insurance Status Disparities in Neurosurgical Care for Intracranial Tumors. World Neurosurg 2021; 158:38-64. [PMID: 34710578 DOI: 10.1016/j.wneu.2021.10.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The impact of race, socioeconomic status (SES), insurance status, and other social metrics on the outcomes of patients with intracranial tumors has been reported in several studies. However, these findings have not been comprehensively summarized. METHODS We conducted a PRISMA systematic review of all published articles between 1990 and 2020 that analyzed intracranial tumor disparities, including race, SES, insurance status, and safety-net hospital status. Outcomes measured include access, standards of care, receipt of surgery, extent of resection, mortality, complications, length of stay (LOS), discharge disposition, readmission rate, and hospital charges. RESULTS Fifty-five studies were included. Disparities in mortality were reported in 27 studies (47%), showing minority status and lower SES associated with poorer survival outcomes in 14 studies (52%). Twenty-seven studies showed that African American patients had worse outcomes across all included metrics including mortality, rates of surgical intervention, extent of resection, LOS, discharge disposition, and complication rates. Thirty studies showed that privately insured patients and patients with higher SES had better outcomes, including lower mortality, complication, and readmission rates. Six studies showed that worse outcomes were associated with treatment at safety-net and/or low-volume hospitals. The influence of Medicare or Medicaid status, or inequities affecting other minorities, was less clearly delineated. Ten studies (18%) were negative for evidence of disparities. CONCLUSIONS Significant disparities exist among patients with intracranial tumors, particularly affecting patients of African American race and lower SES. Efforts at the hospital, state, and national level must be undertaken to identify root causes of these issues.
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Socioeconomic Status and Adult Gliomas Mortality Risk: An Observational Study Based on SEER Data. World Neurosurg 2021; 155:e131-e141. [PMID: 34403798 DOI: 10.1016/j.wneu.2021.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is presented as a complex structure and has not been studied adequately among adult patients with glioma. This study aims to identify the intrinsic linkages of community-level SES multivariables and discover the effects of the various patterns of these indicators on prognosis of adult gliomas. METHODS Based on data from the SEER (Surveillance Epidemiology and End Results) database, 44,816 adults diagnosed with gliomas from 2007 to 2016 were enrolled for the research. We first used factor analysis and cluster analysis to process SES data. Then, univariable and multivariable Cox proportional hazards models were used to analyze the risk indicators. RESULTS Four integrated SES factors were identified: factor 1, economic and social disadvantage (economic and education disadvantage); factor 2, immigration-associated characteristics (foreign-born, language isolation, less household room, recent interstate residential stability); factor 3, housing instability; and factor 4, absence of intrastate mobility. Factor 1 was a risk indicator for survival, whereas factor 2 and factor 4 were protective indicators. All patients fell into 7 cluster groups. Compared with cluster 1, clusters 2, 3, 4, and 7 had a better prognosis, whereas cluster 6 had a shorter survival. CONCLUSIONS The combinatorial patterns of SES indicators and pattern-based groups do influence the outcomes of adult gliomas. Special attention is given to patients living in areas with specialized economic-educational disadvantages, relocation instability, and immigration-related characteristics.
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Tosoni A, Gatto L, Franceschi E, Di Nunno V, Lodi R, Mura A, Di Battista M, Bartolini S, Brandes AA. Association between socioeconomic status and survival in glioblastoma: An Italian single-centre prospective observational study. Eur J Cancer 2021; 145:171-178. [PMID: 33486440 DOI: 10.1016/j.ejca.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND To date, no prospective study has been conducted to investigate the role of socioeconomic status (SES) on clinical outcome of glioblastoma (GBM) in Italy, where there is a National Health Service that provides universal coverage regardless of the patient's economic status. METHODS We performed a prospective observational study investigating the association between SES and survival in GBM patients at our institution, a hub centre for brain cancer research and treatment. We included GBM patients who underwent medical treatment or chemo-radiation between April 2017 and December 2017. The SES was measured using the income-brackets, attributed by the Italian Ministry of Finance on the basis of the income of the fiscal family unit, referring to the previous year. RESULTS One hundred and six patients were included in the study. In multivariate analysis, overall survival (OS) correlated significantly with higher-income (HR = 0.623.95% CI 0.467-0.832; p = 0.001) and MGMT methylation status (HR = 0.158.95% CI 0.082-0.304; P < 0.001). When adjusted for age, performance status and extension of surgery, survival benefit remained superior for higher-income HR = 0.641 (95% CI 0.478-0.858; p = 0.003) and MGMT methylated tumours HR = 0.167 (95% CI 0.084-0.331; p < 0.001). CONCLUSIONS SES is an important determinant of prognosis in GBM even in the Italian National Health Service, which provides universal, largely free and relatively comprehensive healthcare. Despite aspirations to achieve equality in healthcare, socioeconomic differences exist and may impact the clinical outcome.
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Affiliation(s)
- Alicia Tosoni
- Department of Medical Oncology, Azienda USL of Bologna, Bologna, Italy
| | - Lidia Gatto
- Department of Medical Oncology, Azienda USL of Bologna, Bologna, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Azienda USL of Bologna, Bologna, Italy.
| | - Vincenzo Di Nunno
- Department of Medical Oncology, Azienda USL of Bologna, Bologna, Italy
| | - Raffaele Lodi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Antonella Mura
- Department of Medical Oncology, Azienda USL of Bologna, Bologna, Italy
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Toor H, Savla P, Podkovik S, Patchana T, Ghanchi H, Kashyap S, Tashjian V, Miulli D. Timing of Chemoradiation in Newly Diagnosed Glioblastoma: Comparative Analysis Between County and Managed Care Health Care Models. World Neurosurg 2021; 149:e1038-e1042. [PMID: 33476782 DOI: 10.1016/j.wneu.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is a primary brain malignancy with significant morbidity and mortality. The current standard of treatment for GBM is surgery followed by radiotherapy and temozolomide. Despite an established treatment protocol, there exists heterogeneity in outcomes due to patients not receiving all treatments. We analyzed patients in different health care models to investigate this heterogeneity. METHODS A retrospective analysis was performed at 2 hospitals in San Bernardino County, California, for patients with newly diagnosed GBM from 2004 to 2019. Patients younger than 18 years of age, with history of low-grade glioma, who had undergone prior treatment, and those lost to follow-up were excluded. RESULTS A total of 57 patients were included in our study. Chemotherapy was started at 41 ± 30 and 77 ± 68 days in the health maintenance organization (HMO) and county model, respectively (P = 0.050); radiation therapy was started at 46 ± 34 and 85 ± 76 days in the HMO and county models, respectively (P = 0.036). In individuals who underwent both chemotherapy and radiation therapy (XRT), the difference in time to XRT was no longer significant (P = 0.060). Recurrence time was 309 ± 263 and 212 ± 180 days in the HMO and county groups, respectively (P = 0.379). The time to death was 412 ± 285 and 343 ± 304 days for HMO and county models, respectively (P = 0.334). CONCLUSIONS Our study demonstrates a statistically significant difference in time to adjuvant therapies between patients within a county hospital and a managed health care organization. This information has the potential to inform future policies and care coordination for patients within the county model.
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Affiliation(s)
- Harjyot Toor
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Paras Savla
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA.
| | - Stacey Podkovik
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Tye Patchana
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Hammad Ghanchi
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Samir Kashyap
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Vartan Tashjian
- Department of Neurological Surgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
| | - Dan Miulli
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
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Ambe S, Lyon KA, Oh J, Rogers MKN, Olanipekun O, Basil NN, Fonkem E. Racial Disparities in Malignant Primary Brain Tumor Survival in Texas From 1995 to 2013. Cureus 2020; 12:e11710. [PMID: 33391943 PMCID: PMC7769829 DOI: 10.7759/cureus.11710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Differences among the top five races in Texas will be explored to determine if racial, geographic, and healthcare disparities exist in patients undergoing treatment for a primary malignant brain tumor. METHODS Data were obtained from the Texas Cancer Registry from 1995 to 2013. SAS 9.3 (SAS Institute, Inc., Cary, NC) and SEER*Stat 8.3.2 (National Cancer Institute, Bethesda, MD) software were used to analyze death from malignant brain tumors and cause-specific survival. Survival rates were compared using Kaplan-Meier curves and Log-Rank tests. Hazard ratios were estimated using the Cox proportional hazards regression model. RESULTS Median survival was highest among Asians at 92 months (95% CI: 72, 142) and least among Whites at 20 months (95% CI: 19, 21). Patients living in the Upper Gulf Coast region of Texas had the longest survival time at 31 months (95% CI 29-35%), while those patients in the Texas Panhandle had the shortest survival time at 18 months (95% CI 14-23%). Patients with a poverty index of 0-5% had the highest median survival time of 32 months (95% CI 29-35%), as compared to patients with a poverty index of 10-20% who had a median survival of 22 months (95% CI 21-24%). CONCLUSIONS Ethnic minorities and higher socioeconomic class demonstrated survival advantage. White males had the worst survival of those with primary malignant brain tumors. Other significant factors affecting a patient's survival rate included geographic location, poverty index, sex, and age, thus suggesting a potential genetic and environmental influence.
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Affiliation(s)
- Solomon Ambe
- Neurology, Tulane University School of Medicine, New Orleans, USA
| | - Kristopher A Lyon
- Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Janice Oh
- Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
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Brewster R, Deb S, Pendharkar AV, Ratliff J, Li G, Desai A. The effect of socioeconomic status on age at diagnosis and overall survival in patients with intracranial meningioma. Int J Neurosci 2020; 132:413-420. [PMID: 32878534 DOI: 10.1080/00207454.2020.1818742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intracranial meningiomas are the most common primary tumors of the central nervous system. How socioeconomic status (SES) impacts treatment access and outcomes for brain tumor subtypes is an emerging area of research. Few studies have examined the relationship between SES and meningioma survival and management with reference to relevant clinical factors, including age at diagnosis. We studied the independent effects of SES on receiving surgery and survival probability in patients with intracranial meningioma. METHODS 54,282 patients diagnosed with intracranial meningioma between 2003 and 2012 from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute database were included. Patient SES was divided into tertiles. Patient age groups included 'older' (>65, the median patient age) and 'younger'. Multivariable linear regression and Cox proportional hazards model were used with SAS v9.4. Results were adjusted for race, sex, and tumor grade. Kaplan-Meier survival curves were constructed according to SES tertiles and age groups. RESULTS Meningioma prevalence increased with higher SES tertile. Higher SES tertile was also associated with younger age at diagnosis (OR = 0.890, p < 0.05), an increased likelihood of undergoing gross total resection (GTR) (OR = 1.112, p < 0.05), and a trend toward greater 5-year survival probability (HR = 1.773, p = 0.0531). Survival probability correlated with younger age at diagnosis (HR = 2.597, p < 0.001), but not with GTR receipt. CONCLUSION The findings from this national longitudinal study on patients with meningioma suggest that SES affects age at diagnosis and treatment access for intracranial meningiomas patients. Further studies are required to understand and address the mechanisms underlying these disparities.
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Affiliation(s)
- Ryan Brewster
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sayantan Deb
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Arjun Vivek Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - John Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Atman Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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Racial and socioeconomic disparities differentially affect overall and cause-specific survival in glioblastoma. J Neurooncol 2020; 149:55-64. [PMID: 32617722 DOI: 10.1007/s11060-020-03572-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The prognostic role of racial and socioeconomic factors in patients with glioblastoma is controversially debated. We aimed to evaluate how these factors may affect survival outcomes in an overall and cause-specific manner using large, national cancer registry cohort data in the temozolomide chemoradiation era. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with glioblastoma between 2005 and 2016. Overall survival was assessed using Cox proportional hazard models using disease intrinsic and extrinsic factors. Cause-specific mortality was assessed using cumulative incidence curves and modeled using multivariate cumulative risk regression. RESULTS A total of 28,952 patients met the prespecified inclusion criteria and were included in this analysis. The following factors were associated with all-cause mortality: age, calendar year of diagnosis, sex, treatment receipt, tumor size, tumor location, extent of resection, median household income, and race. Asian/Pacific Islanders and Hispanic Whites had lower mortality compared to Non-Hispanic Whites. Cause-specific mortality was associated with both racial and socioeconomic groups. After adjusting for treatment and tumor-related factors, Asian/Pacific and black patients had lower glioblastoma-specific mortality. However, lower median household income and black race were associated with significantly higher non-glioblastoma mortality. CONCLUSIONS Despite the aggressive nature of glioblastoma, racial and socioeconomic factors influence glioblastoma-specific and non-glioblastoma associated mortality. Our study shows that patient race has an impact on glioblastoma-associated mortality independently of tumor and treatment related factors. Importantly, socioeconomic and racial differences largely contribute to non-glioblastoma mortality, including death from other cancers, cardio- and cerebrovascular events.
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Taha B, Winston G, Tosi U, Hartley B, Hoffman C, Dahmane N, Mason CE, Greenfield JP. Missing diversity in brain tumor trials. Neurooncol Adv 2020; 2:vdaa059. [PMID: 32642711 PMCID: PMC7316223 DOI: 10.1093/noajnl/vdaa059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Clinical trials for brain tumors represent a significant opportunity for both patients and providers to understand and combat a disease with substantial morbidity. The aim of this study was to quantify and map ethnic and racial representation in brain tumor trials and examine the potential gaps in trial recruitment. We also show that these representation gaps persist even in large multicultural cities like New York City. Methods We analyzed brain tumor clinical trials registered on www.clinicaltrials.gov between July 1, 2005 and completed on or before November 11, 2017. We used a combination of PubMed/MEDLINE and Google Scholar to find associated publications and obtained trial information as well as patient demographic information (when available) including race or ancestry. Results Out of 471 trials, 27% had no published results. Only 28.4% of trials with results reported race or ethnicity of trial participants, with no observed upward trend by year. Whites were significantly overrepresented in trials for metastatic brain tumors (P < .001) and high-grade trials (P < .001). Blacks/African Americans (AAs), Hispanics, and Asians were significantly underrepresented (P < .001) in high-grade trials, while only Blacks/AAs were underrepresented in trials for metastatic brain tumors (P < .001). Representation gaps were not observed in pediatric trials. Despite being a multicultural hub, New York City displayed similar gaps in trial representation. Conclusions Despite increasing representation in the American population, minorities are underrepresented in brain tumor trials. In addition, despite numerous legal requirements and ethical mandates, published results including race-based information are remarkably absent from 70% of brain tumor trials.
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Affiliation(s)
- Birra Taha
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Graham Winston
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Umberto Tosi
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Benjamin Hartley
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Caitlin Hoffman
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Nadia Dahmane
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Christopher E Mason
- Department of Physiology and Biophysics and Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA.,Feil Family Brain and Mind Research Institute, New York, NY, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Wang T, Pham A, Yoo S, Attenello FJ, Jennelle R, Wagle N, Chang EL, Zada G. Identifying Disparities in Care in Treating Glioblastoma: A Retrospective Cohort Study of Patients Treated at a Safety-net Versus Private Hospital Setting. World Neurosurg 2020; 137:e213-e220. [PMID: 32001415 DOI: 10.1016/j.wneu.2020.01.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients of lower socioeconomic status (SES) may experience barriers to their oncologic care, but current data conflict over whether SES affects the prognosis of patients with glioblastoma (GB). OBJECTIVE We sought to determine whether SES disparities impaired delivery of neuro-oncologic care and affected the prognosis of GB patients. METHODS The records of GB patients treated from 2010 to 2014 at a safety-net hospital (SNH) or private hospital (PH), both served by 1 academic medical institution, were retrospectively reviewed and compared. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. RESULTS A total of 55 SNH and 39 PH GB patients were analyzed with median 11-month follow-up. SNH patients were predominantly Hispanic, low income, enrolled in Medicaid, were less likely to receive radiation (89% vs. 100%), took longer to start radiation (41 vs. 29 days), and were less likely to complete radiation treatment (80% vs. 95%). Concurrent and adjuvant temozolomide use were also lower (85% vs. 94% and 60% vs. 71%, respectively). OS and PFS were not significantly different (15 vs. 16 months and 8 vs. 11 months, respectively). On multivariate analysis, adjuvant chemotherapy and RT completion predicted for better OS, whereas hospital type, income, and insurance did not. CONCLUSION Although GB patients at our SNH received less adjuvant treatment compared with PH, outcomes were similar. Access to multidisciplinary care staffed by academic physicians may play an important role in overcoming socioeconomic barriers to treatment availability and quality at SNHs.
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Affiliation(s)
- Theodore Wang
- Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Anthony Pham
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
| | - Stella Yoo
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Frank J Attenello
- Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA; Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Richard Jennelle
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Naveed Wagle
- Department of Clinical Neurology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Chandra A, Rick JW, Dalle Ore C, Lau D, Nguyen AT, Carrera D, Bonte A, Molinaro AM, Theodosopoulos PV, McDermott MW, Berger MS, Aghi MK. Disparities in health care determine prognosis in newly diagnosed glioblastoma. Neurosurg Focus 2019; 44:E16. [PMID: 29852776 DOI: 10.3171/2018.3.focus1852] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Glioblastoma (GBM) is an aggressive brain malignancy with a short overall patient survival, yet there remains significant heterogeneity in outcomes. Although access to health care has previously been linked to impact on prognosis in several malignancies, this question remains incompletely answered in GBM. METHODS This study was a retrospective analysis of 354 newly diagnosed patients with GBM who underwent first resection at the authors' institution (2007-2015). RESULTS Of the 354 patients (median age 61 years, and 37.6% were females), 32 (9.0%) had no insurance, whereas 322 (91.0%) had insurance, of whom 131 (40.7%) had Medicare, 45 (14%) had Medicaid, and 146 (45.3%) had private insurance. On average, insured patients survived almost 2-fold longer (p < 0.0001) than those who were uninsured, whereas differences between specific insurance types did not influence survival. The adjusted hazard ratio (HR) for death was higher in uninsured patients (HR 2.27 [95% CI 1.49-3.33], p = 0.0003). Age, mean household income, tumor size at diagnosis, and extent of resection did not differ between insured and uninsured patients, but there was a disparity in primary care physician (PCP) status-none of the uninsured patients had PCPs, whereas 72% of insured patients had PCPs. Postoperative adjuvant treatment rates with temozolomide (TMZ) and radiation therapy (XRT) were significantly less in uninsured (TMZ in 56.3%, XRT in 56.3%) than in insured (TMZ in 75.2%, XRT in 79.2%; p = 0.02 and p = 0.003) patients. Insured patients receiving both agents had better prognosis than uninsured patients receiving the same treatment (9.1 vs 16.34 months; p = 0.025), suggesting that the survival effect in insured patients could only partly be explained by higher treatment rates. Moreover, having a PCP increased survival among the insured cohort (10.7 vs 16.1 months, HR 1.65 [95% CI 1.27-2.15]; p = 0.0001), which could be explained by significant differences in tumor diameter at initial diagnosis between patients with and without PCPs (4.3 vs 4.8 cm, p = 0.003), and a higher rate of clinical trial enrollment, suggesting a critical role of PCPs for a timelier diagnosis of GBM and proactive cancer care management. CONCLUSIONS Access to health care is a strong determinant of prognosis in newly diagnosed patients with GBM. Any type of insurance coverage and having a PCP improved prognosis in this patient cohort. Higher rates of treatment with TMZ plus XRT, clinical trial enrollment, fewer comorbidities, and early diagnosis may explain survival disparities. Lack of health insurance or a PCP are major challenges within the health care system, which, if improved upon, could favorably impact the prognosis of patients with GBM.
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Brown DA, Himes BT, Kerezoudis P, Chilinda-Salter YM, Grewal SS, Spear JA, Bydon M, Burns TC, Parney IF. Insurance correlates with improved access to care and outcome among glioblastoma patients. Neuro Oncol 2019; 20:1374-1382. [PMID: 29893906 DOI: 10.1093/neuonc/noy102] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The current standard of care for glioblastoma (GBM) constitutes maximal safe surgical resection, followed by fractionated radiation and temozolomide. This treatment regimen is logistically burdensome, and in a health care system in which access to care is variable, there may be patients with worsened outcomes due to inadequate access to optimal treatment. Methods The National Cancer Database was queried for patients with diagnoses of GBM in 2006-2014. Patients were grouped according to insurance status: private insurance, Medicare, Medicaid, or uninsured. Treatments provided (surgery, radiation, and chemotherapy) were compared between groups in univariate and multivariable logistic regression analysis. Results A total of 61614 patients were analyzed. Compared with private insurance, the odds of surgery for Medicaid and uninsured patients were 0.72 (95% CI: 0.66-0.79) and 0.77 (95% CI: 0.69-0.87), respectively (P < 0.001). The multivariable odds of receiving radiotherapy were 0.91 (95% CI: 0.86-0.96), 0.62 (95% CI: 0.57-0.68), and 0.47 (95% CI: 0.43-0.52) for Medicare, Medicaid, and uninsured patients, respectively (all P < 0.001). In addition, the odds of receiving chemotherapy were 0.94 (95% CI: 0.89-0.99), 0.53 (95% CI: 0.49-0.57), and 0.41 (95% CI: 0.38-0.46) for Medicare, Medicaid, and uninsured patients, respectively (all P < 0.001). Conclusion Insurance status and type of insurance coverage appear to impact treatments rendered for GBM, independently of other variables. Furthermore, we find that such differential access to care significantly impacts survival. Ensuring adequate access to care for all patients with diagnoses of glioblastoma is critical to optimize survival, especially as therapies continue to advance.
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Affiliation(s)
- Desmond A Brown
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Benjamin T Himes
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Panagiotis Kerezoudis
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | | | - Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joshua A Spear
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Terry C Burns
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ian F Parney
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Ryckman JM, Ganesan V, Kusi Appiah A, Zhang C, Verma V. National practice patterns of proton versus photon therapy in the treatment of adult patients with primary brain tumors in the United States. Acta Oncol 2019; 58:66-73. [PMID: 30280620 DOI: 10.1080/0284186x.2018.1512755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine patterns of care associated with the administration of proton versus photon therapy for adult patients with primary brain tumors in a large national cohort from the United States. METHODS The National Cancer Database (NCDB) was queried for newly diagnosed primary brain tumors (2004-2014) in adult patients aged 18 and older receiving proton or photon radiotherapy. Clinical features, patient demographics and treatment parameters were extracted. Differences between groups were assessed using multivariable logistic regression analysis. RESULTS In total, 73,073 patients were analyzed (n = 72,635 [99.4%] photon therapy, n = 438 [0.6%] proton therapy). On multivariable analysis of photon versus proton therapy, several factors predicted for receipt of proton therapy, including younger age (p = .041), highest income quartile (p = .007), treatment at academic institutions (p < .001), in regional facilities outside the Midwest/South (p < .001), diagnosis in more recent years (p = .003), fewer comorbidities (p < .001) and non-glioblastoma histology (p < .001). CONCLUSIONS There are several significant socioeconomic variables that influence receipt of proton therapy for primary brain tumors. Although not implying causation, the socioeconomic findings discovered herein should be taken into account when delivering cancer care to all patients.
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Affiliation(s)
- Jeffrey M. Ryckman
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vaishnavi Ganesan
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Adams Kusi Appiah
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Chi Zhang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
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Perdomo-Pantoja A, Mejía-Pérez SI, Reynoso-Noverón N, Gómez-Flores-Ramos L, Soto-Reyes E, Sánchez-Correa TE, Guerra-Calderas L, Castro-Hernandez C, Vidal-Millán S, Sánchez-Corona J, Taja-Chayeb L, Gutiérrez O, Cacho-Diaz B, Alvarez-Gomez RM, Gómez-Amador JL, Ostrosky-Wegman P, Corona T, Herrera-Montalvo LA, Wegman-Ostrosky T. Angiotensinogen rs5050 germline genetic variant as potential biomarker of poor prognosis in astrocytoma. PLoS One 2018; 13:e0206590. [PMID: 30383794 PMCID: PMC6211735 DOI: 10.1371/journal.pone.0206590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/16/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Renin-angiotensin system (RAS) in brain cancer represents a scarcely explored field in neuro-oncology. Recently, some pre- and clinical studies have reported that RAS components play a relevant role in the development and behavior of gliomas. The angiotensinogen (AGT) rs5050 genetic variant has been identified as a crucial regulator of the transcription of AGT mRNA, which makes it a logical and promising target of research. The aim of this study was to determine the relationship between the AGT rs5050 genetic variant in blood with prognosis in astrocytoma. Methods A prospective pilot study was performed on forty-eight astrocytoma patients, who received the standard-of-care treatment. Blood samples were taken prior to surgery and DNA was sequenced using Ion Torrent next-generation sequencing and analyzed by Ion Reporter software. Descriptive, bivariate, multivariate, and survival analyses were performed using SPSS v21, STATA 12 and GraphPad Prism 7. Results Median follow-up was 41 months (range 1–48). Survival analysis showed a significant difference between the rs5050 genotypes (p = .05). We found lower survival rates in individuals with the GG-genotype of rs5050 AGT compared to patients with the TT- and TG-genotype (2 months vs. 11.5 months, respectively [p = .01]). In bivariate and multivariate analyses, GG-genotype was negatively associated with survival. Conclusions In patients with astrocytoma, AGT rs5050 GG-genotype was associated with poor prognosis. We propose this germline genetic variant as a complementary biomarker, which can be detected practically and safely in blood samples or saliva.
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Affiliation(s)
- Alexander Perdomo-Pantoja
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, "Manuel Velasco Suarez", Mexico City, Mexico
| | - Sonia Iliana Mejía-Pérez
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, "Manuel Velasco Suarez", Mexico City, Mexico
| | | | | | - Ernesto Soto-Reyes
- Dirección de Investigación, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Clementina Castro-Hernandez
- Unidad de Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM-INCAN, Mexico City, Mexico
| | - Silvia Vidal-Millán
- Dirección de Investigación, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Lucia Taja-Chayeb
- Dirección de Investigación, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Olga Gutiérrez
- Dirección de Investigación, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Bernardo Cacho-Diaz
- Unidad de Neuro-oncologia, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Juan Luis Gómez-Amador
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, "Manuel Velasco Suarez", Mexico City, Mexico
| | - Patricia Ostrosky-Wegman
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Teresa Corona
- Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurologia y Neurocirugia, "Manuel Velasco Suarez", Mexico City, Mexico
| | - Luis Alonso Herrera-Montalvo
- Dirección de Investigación, Instituto Nacional de Cancerología, Mexico City, Mexico
- Unidad de Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM-INCAN, Mexico City, Mexico
| | - Talia Wegman-Ostrosky
- Dirección de Investigación, Instituto Nacional de Cancerología, Mexico City, Mexico
- * E-mail:
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23
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Alicandro G, Frova L, Sebastiani G, El Sayed I, Boffetta P, La Vecchia C. Educational inequality in cancer mortality: a record linkage study of over 35 million Italians. Cancer Causes Control 2017; 28:997-1006. [PMID: 28748345 DOI: 10.1007/s10552-017-0930-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Large studies are needed to evaluate socioeconomic inequality for site-specific cancer mortality. We conducted a longitudinal census-based national study to quantify the relative inequality in cancer mortality among educational levels in Italy. METHODS We linked the 2011 Italian census with the 2012 and 2013 death registries. Educational inequality in overall cancer and site-specific cancer mortality were evaluated by computing the mortality rate ratio (MRR). RESULTS A total of 35,708,445 subjects aged 30-74 years and 147,981 cancer deaths were registered. Compared to the lowest level of education (none or primary school), the MRR for all cancers in the highest level (university) was 0.57 (95% CI 0.55; 0.58) in men and 0.84 (95% CI 0.81; 0.87) in women. Higher education was associated with reduced risk of mortality from lip, oral cavity, pharynx, oesophagus, stomach, colon and liver in both sexes. Higher education (university) was associated with decreased risk of lung cancer in men (MRR: 0.43, 95% CI 0.41; 0.46), but not in women (MRR: 1.00, 95% CI 0.92; 1.10). Highly educated women had a reduced risk of mortality from cervical cancer than lower educated women (MRR: 0.39, 95% CI 0.27; 0.56), but they had a similar risk for breast cancer (MRR: 1.01, 95% CI 0.94; 1.09). CONCLUSIONS Education is inversely associated with total cancer mortality, and the association was stronger in men. Different patterns and trends in tobacco smoking in men and women account for at least most of the gender differences.
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Affiliation(s)
- Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133, Milan, Italy. .,Italian National Institute of Statistics, Via Cesare Balbo 16, 00184, Rome, Italy.
| | - Luisa Frova
- Italian National Institute of Statistics, Via Cesare Balbo 16, 00184, Rome, Italy
| | - Gabriella Sebastiani
- Italian National Institute of Statistics, Via Cesare Balbo 16, 00184, Rome, Italy
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara Alexandria, Egypt
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, 1190 5th Ave, New York, NY, 10029, USA
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133, Milan, Italy
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24
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Luksik AS, Garzon-Muvdi T, Yang W, Huang J, Jallo GI. Pediatric spinal cord astrocytomas: a retrospective study of 348 patients from the SEER database. J Neurosurg Pediatr 2017; 19:711-719. [PMID: 28362182 DOI: 10.3171/2017.1.peds16528] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Intramedullary spinal cord tumors comprise 1%-10% of all childhood central nervous system neoplasms, with astrocytomas representing the most common subtype. Due to their rarity and poor prognosis, large population-based studies are needed to assess the epidemiology and survival risk factors associated with these tumors in the hope of improving outcome. The authors undertook this retrospective study to explore factors that may influence survival in pediatric patients with spinal cord astrocytomas. METHODS Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, a prospective cancer registry, the authors retrospectively assessed survival in histologically confirmed, primary spinal cord astrocytomas in patients 21 years of age and younger. Survival was described with Kaplan-Meyer curves, and a multivariate regression analysis was used to assess the association of several variables with survival while controlling for confounding variables. RESULTS This analysis of 348 cases showed that age (hazard ratio [HR] 1.05, 95% CI 1.01-1.09, p = 0.017), nonwhite race (HR 1.74, 95% CI 1.11-2.74, p = 0.014), high-grade tumor status (HR 14.67, 95% CI 6.69-32.14, p < 0.001), distant or invasive extension of the tumor (HR 2.37, 95% CI 1.02-5.49, p = 0.046), and radiation therapy (HR 3.74, 95% CI 2.18-6.41, p < 0.001) were associated with decreased survival. Partial resection (HR 0.37, 95% CI 0.16-0.83, p = 0.017) and gross-total resection (HR 0.39, 95% CI 0.16-0.95, p = 0.039) were associated with improved survival. CONCLUSIONS Younger age appears to be protective, while high-grade tumors have a much worse prognosis. Early diagnosis and access to surgery appears necessary for improving outcomes, while radiation therapy has an unclear role. There is still much to learn about this disease in the hope of curing children with the misfortune of having one of these rare tumors.
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Affiliation(s)
- Andrew S Luksik
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Wuyang Yang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Judy Huang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - George I Jallo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and.,Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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25
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The effect of socioeconomic status on gross total resection, radiation therapy and overall survival in patients with gliomas. J Neurooncol 2017; 132:447-453. [DOI: 10.1007/s11060-017-2391-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 02/23/2017] [Indexed: 01/27/2023]
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