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Management of glioblastoma at safety-net hospitals

  • Clinical Study
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Journal of Neuro-Oncology Aims and scope Submit manuscript

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.

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Funding

The project described was partially supported by the National Institutes of Health, Pre-doctoral Grant TL1TR001443 awarded to MGB and RRS.

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Authors and Affiliations

  1. Department of Neurosurgery, University of California, San Diego, 9300 Campus Point Drive, La Jolla, Mail Code 7893, San Diego, CA, 92037, USA

    Michael G. Brandel, Robert C. Rennert, Christian Lopez Ramos, David R. Santiago-Dieppa, Jeffrey A. Steinberg, Arvin R. Wali, J. Scott Pannell & Alexander A. Khalessi

  2. Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, San Diego, CA, USA

    Reith R. Sarkar & James D. Murphy

  3. Clinical and Translational Research Institute, University of California, San Diego, La Jolla, San Diego, CA, USA

    James D. Murphy

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  1. Michael G. Brandel
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Correspondence to Alexander A. Khalessi.

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Brandel, M.G., Rennert, R.C., Lopez Ramos, C. et al. Management of glioblastoma at safety-net hospitals. J Neurooncol 139, 389–397 (2018). https://doi.org/10.1007/s11060-018-2875-8

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