Michael G Brandel1, Robert C Rennert1, Christian Lopez Ramos1, David R Santiago-Dieppa1, Jeffrey A Steinberg1, Reith R Sarkar2, Arvin R Wali1, J Scott Pannell1, James D Murphy2,3, Alexander A Khalessi4. 1. Department of Neurosurgery, University of California, San Diego, 9300 Campus Point Drive, La Jolla, Mail Code 7893, San Diego, CA, 92037, USA. 2. Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, San Diego, CA, USA. 3. Clinical and Translational Research Institute, University of California, San Diego, La Jolla, San Diego, CA, USA. 4. Department of Neurosurgery, University of California, San Diego, 9300 Campus Point Drive, La Jolla, Mail Code 7893, San Diego, CA, 92037, USA. akhalessi@ucsd.edu.
Abstract
BACKGROUND: Safety-net hospitals (SNHs) provide disproportionate care for underserved patients. Prior studies have identified poor outcomes, increased costs, and reduced access to certain complex, elective surgeries at SNHs. However, it is unknown whether similar patterns exist for the management of glioblastoma (GBM). We sought to determine if patients treated at HBHs receive equitable care for GBM, and if safety-net burden status impacts post-treatment survival. METHODS: The National Cancer Database was queried for GBM patients diagnosed between 2010 and 2015. Safety-net burden was defined as the proportion of Medicaid and uninsured patients treated at each hospital, and stratified as low (LBH), medium (MBH), and high-burden (HBH) hospitals. The impact of safety-net burden on the receipt of any treatment, trimodality therapy, gross total resection (GTR), radiation, or chemotherapy was investigated. Secondary outcomes included post-treatment 30-day mortality, 90-day mortality, and overall survival. Univariate and multivariate analyses were utilized. RESULTS: Overall, 40,082 GBM patients at 1202 hospitals (352 LBHs, 553 MBHs, and 297 HBHs) were identified. Patients treated at HBHs were significantly less likely to receive trimodality therapy (OR = 0.75, p < 0.001), GTR (OR = 0.84, p < 0.001), radiation (OR = 0.73, p < 0.001), and chemotherapy (OR = 0.78, p < 0.001) than those treated at LBHs. Patients treated at HBHs had significantly increased 30-day (OR = 1.25, p = 0.031) and 90-day mortality (OR = 1.24, p = 0.001), and reduced overall survival (HR = 1.05, p = 0.039). CONCLUSIONS: GBM patients treated at SNHs are less likely to receive standard-of-care therapies and have increased short- and long-term mortality. Additional research is needed to evaluate barriers to providing equitable care for GBM patients at SNHs.
BACKGROUND: Safety-net hospitals (SNHs) provide disproportionate care for underserved patients. Prior studies have identified poor outcomes, increased costs, and reduced access to certain complex, elective surgeries at SNHs. However, it is unknown whether similar patterns exist for the management of glioblastoma (GBM). We sought to determine if patients treated at HBHs receive equitable care for GBM, and if safety-net burden status impacts post-treatment survival. METHODS: The National Cancer Database was queried for GBM patients diagnosed between 2010 and 2015. Safety-net burden was defined as the proportion of Medicaid and uninsured patients treated at each hospital, and stratified as low (LBH), medium (MBH), and high-burden (HBH) hospitals. The impact of safety-net burden on the receipt of any treatment, trimodality therapy, gross total resection (GTR), radiation, or chemotherapy was investigated. Secondary outcomes included post-treatment 30-day mortality, 90-day mortality, and overall survival. Univariate and multivariate analyses were utilized. RESULTS: Overall, 40,082 GBM patients at 1202 hospitals (352 LBHs, 553 MBHs, and 297 HBHs) were identified. Patients treated at HBHs were significantly less likely to receive trimodality therapy (OR = 0.75, p < 0.001), GTR (OR = 0.84, p < 0.001), radiation (OR = 0.73, p < 0.001), and chemotherapy (OR = 0.78, p < 0.001) than those treated at LBHs. Patients treated at HBHs had significantly increased 30-day (OR = 1.25, p = 0.031) and 90-day mortality (OR = 1.24, p = 0.001), and reduced overall survival (HR = 1.05, p = 0.039). CONCLUSIONS: GBM patients treated at SNHs are less likely to receive standard-of-care therapies and have increased short- and long-term mortality. Additional research is needed to evaluate barriers to providing equitable care for GBM patients at SNHs.
Entities:
Keywords:
Chemoradiation; Glioblastoma; Gross total resection; Safety-net hospitals; Trimodality therapy
Authors: Andrew Brodbelt; David Greenberg; Tim Winters; Matt Williams; Sally Vernon; V Peter Collins Journal: Eur J Cancer Date: 2015-02-03 Impact factor: 9.162
Authors: Richard S Hoehn; Koffi Wima; Matthew A Vestal; Drew J Weilage; Dennis J Hanseman; Daniel E Abbott; Shimul A Shah Journal: JAMA Surg Date: 2016-02 Impact factor: 14.766
Authors: S C Schold; J E Herndon; P C Burger; E C Halperin; N A Vick; J G Cairncross; D R Macdonald; E J Dropcho; R Morawetz; D D Bigner Journal: J Clin Oncol Date: 1993-01 Impact factor: 44.544
Authors: E C Halperin; J Herndon; S C Schold; M Brown; N Vick; J G Cairncross; D R Macdonald; L Gaspar; B Fischer; E Dropcho; S Rosenfeld; R Morowitz; J Piepmeier; W Hait; T Byrne; M Salter; J Imperato; J Khandekar; N Paleologos; P Burger; G C Bentel; A Friedman Journal: Int J Radiat Oncol Biol Phys Date: 1996-03-01 Impact factor: 7.038
Authors: Krissia M Rivera Perla; Oliver Y Tang; Shayla N M Durfey; Tito Vivas-Buitrago; Wendy J Sherman; Ian Parney; Joon H Uhm; Alyx B Porter; Heinrich Elinzano; Steven A Toms; Alfredo Quiñones-Hinojosa Journal: J Neurooncol Date: 2022-05-03 Impact factor: 4.130
Authors: Oliver Y Tang; Ross A Clarke; Krissia M Rivera Perla; Kiara M Corcoran Ruiz; Steven A Toms; Robert J Weil Journal: J Neurooncol Date: 2022-01-13 Impact factor: 4.130
Authors: Charlotte R Gamble; Yongmei Huang; Ana I Tergas; Fady Khoury-Collado; June Y Hou; Caryn M St Clair; Cande V Ananth; Alfred I Neugut; Dawn L Hershman; Jason D Wright Journal: JNCI Cancer Spectr Date: 2019-06-07
Authors: Zaid Muslim; Syed S Razi; Kostantinos Poulikidis; M Jawad Latif; Joanna F Weber; Cliff P Connery; Faiz Y Bhora Journal: JTCVS Open Date: 2022-07-11