Victor M Lu1,2, Cole T Lewis3, Yoshua Esquenazi3. 1. Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida. 2. Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. 3. Vivian L. Smith Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas.
Abstract
BACKGROUND: Treatment for glioblastoma (GBM) in elderly (age > 65 years) patients can be affected by multiple geographic and socioeconomic parameters. Correspondingly, the aim of this study was to determine trends in treatment of elderly GBM patients in the United States. METHODS: All GBM patients in the U.S. National Cancer Database between 2005 and 2016 were retrospectively reviewed. Status of treatment by triple therapy (resection, chemotherapy, and radiation) were summarized and analyzed by U.S. Census region. RESULTS: There were 44 338 GBM patients included, with 21 573 (49%) elderly and 22 765 (51%) nonelderly patients with median ages 72 years (range, 65-90 years) and 47 years (range, 40-64 years), respectively. Compared to nonelderly patients, elderly patients had significantly lower odds of being treated by triple therapy (odds ratio, OR = 0.54) as a whole, and its individual elements of resection (OR = 0.78), chemotherapy (OR = 0.46), radiation therapy (OR = 0.52). This was reflected in each U.S. Census region, with the lowest odds of being treated with triple therapy, surgical resection, chemotherapy, and radiation therapy in New England (OR = 0.51) Mountain (OR = 0.66), West North Central (OR = 0.38), and the Middle Atlantic (OR = 0.44), respectively. Multivariable analysis revealed multiple socioeconomic parameters that significantly predicted lower odds of triple therapy in the elderly. CONCLUSIONS: In the United States alone, there exists geographic disparity in the treatment outcomes of elderly GBM patients. Multiple socioeconomic parameters can influence access to treatment modalities for elderly patients compared to younger patients in different geographic regions, and public health initiatives targeting these aspects may prove beneficial conceptually to optimize and homogenize clinical outcomes.
BACKGROUND: Treatment for glioblastoma (GBM) in elderly (age > 65 years) patients can be affected by multiple geographic and socioeconomic parameters. Correspondingly, the aim of this study was to determine trends in treatment of elderly GBM patients in the United States. METHODS: All GBM patients in the U.S. National Cancer Database between 2005 and 2016 were retrospectively reviewed. Status of treatment by triple therapy (resection, chemotherapy, and radiation) were summarized and analyzed by U.S. Census region. RESULTS: There were 44 338 GBM patients included, with 21 573 (49%) elderly and 22 765 (51%) nonelderly patients with median ages 72 years (range, 65-90 years) and 47 years (range, 40-64 years), respectively. Compared to nonelderly patients, elderly patients had significantly lower odds of being treated by triple therapy (odds ratio, OR = 0.54) as a whole, and its individual elements of resection (OR = 0.78), chemotherapy (OR = 0.46), radiation therapy (OR = 0.52). This was reflected in each U.S. Census region, with the lowest odds of being treated with triple therapy, surgical resection, chemotherapy, and radiation therapy in New England (OR = 0.51) Mountain (OR = 0.66), West North Central (OR = 0.38), and the Middle Atlantic (OR = 0.44), respectively. Multivariable analysis revealed multiple socioeconomic parameters that significantly predicted lower odds of triple therapy in the elderly. CONCLUSIONS: In the United States alone, there exists geographic disparity in the treatment outcomes of elderly GBM patients. Multiple socioeconomic parameters can influence access to treatment modalities for elderly patients compared to younger patients in different geographic regions, and public health initiatives targeting these aspects may prove beneficial conceptually to optimize and homogenize clinical outcomes.
Authors: Marco Timmer; Matthias Seibl-Leven; Klaus Wittenstein; Stefan Grau; Pantelis Stavrinou; Gabriele Röhn; Boris Krischek; Roland Goldbrunner Journal: World Neurosurg Date: 2019-02-05 Impact factor: 2.104
Authors: James R Perry; Normand Laperriere; Christopher J O'Callaghan; Alba A Brandes; Johan Menten; Claire Phillips; Michael Fay; Ryo Nishikawa; J Gregory Cairncross; Wilson Roa; David Osoba; John P Rossiter; Arjun Sahgal; Hal Hirte; Florence Laigle-Donadey; Enrico Franceschi; Olivier Chinot; Vassilis Golfinopoulos; Laura Fariselli; Antje Wick; Loic Feuvret; Michael Back; Michael Tills; Chad Winch; Brigitta G Baumert; Wolfgang Wick; Keyue Ding; Warren P Mason Journal: N Engl J Med Date: 2017-03-16 Impact factor: 91.245
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