Journal of Neuro-Oncology

, Volume 142, Issue 2, pp 365–374 | Cite as

Effect of health disparities on overall survival of patients with glioblastoma

  • Jacob J. Mandel
  • Michael Youssef
  • Jooyeon Nam
  • Akash J. Patel
  • Ali Jalali
  • Ethan B. Ludmir
  • Diane Liu
  • Jimin Wu
  • Georgina Armstrong
  • Jason Huse
  • Melissa Bondy
  • John F. de GrootEmail author
Clinical Study



Examine the potential effects of health disparities in survival of glioblastoma (GB) patients.


We conducted a retrospective chart review of newly diagnosed GB patients from 2000 to 2015 at a free standing dedicated cancer center (MD Anderson Cancer Center—MDACC) and a safety net county hospital (Ben Taub General Hospital—BT) located in Houston, Texas. We obtained demographics, insurance status, extent of resection, treatments, and other known prognostic variables (Karnofsky Score—KPS) to evaluate their role on overall GB survival (OS).


We identified 1073 GB patients consisting of 177 from BT and 896 from MDACC. We found significant differences by ethnicity, insurance status, KPS at diagnosis, extent of resection, and percentage of patients receiving standard of care (SOC) between the two centers. OS was 1.64 years for MDACC patients and 1.24 years for BT patients (p < 0.0176). Only 81 (45.8%) BT patients received SOC compared to 577 (64%) of MDACC patients (p < 0.0001). However, there was no significant difference in OS for patients who received SOC, 1.84 years for MDACC patients and 1.99 years for BT patients (p < 0.4787). Of the 96 BT patients who did not receive SOC, 29 (30%) had KPS less than 70 at time of diagnosis and 77 (80%) lacked insurance.


GB patients treated at a safety net county hospital had similar OS compared to a free standing comprehensive cancer center when receiving SOC. County hospital patients had poorer KPS at diagnosis and were often lacking health insurance affecting their ability to receive SOC.


Health disparities Race Glioblastoma Insurance Overall survival 


Author contributions

JJM: conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, and writing—review and editing. MY: data curation, formal analysis. JN: data curation, formal analysis. AJP: data curation, writing—review and editing. AJ: data curation, writing—review and editing. EBL: data curation, writing—review and editing. DL: formal analysis, methodology, software, validation. JW: formal analysis, methodology, software, validation. GA: conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, and writing—review and editing. JH: conceptualization, data curation, methodology. MB: conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, and writing—review and editing. JFG: conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, and writing—review and editing.

Compliance with ethical standards

Conflict of interest

Dr. John de Groot—Grant or Research Support: Sanofi-Aventis, Astrazeneca, EMD-Serono; Eli Lilly, Novartis, Deciphera Pharmaceuticals, Mundipharma. Paid Consultant: Celldex; Deciphera Pharmaceuticals, AbbVie, FivePrime Therapeutics, Inc., GW Pharma, Carthera, Eli Lilly, Boston Biomedical Inc.,Taiho Pharmaceuticals, Kairos Venture Investments, Syneos Health, Monteris, Agios, Mundipharma, Blue Earth Diagnostics. Advisory Boards: Genentech, Celldex, Foundation Medicine, Inc., Novogen, Deciphera, Astrazeneca, Insys Therapeutics, Kadmon, Merck, Eli Lilly, Novella Clinical, Blue Earth Diagnostics. Other Relevant Financial or Material Interests: DSMB: VBL Therapeutics; DSMB: Novella; VBI Vaccines, Inc. Stock Ownership: Ziopharm Oncology, Gilead. Company Employment (Spouse): Ziopharm Oncology. None of the other authors have any conflict of interests to report.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors and was a retrospective study performed with approval of the IRB of the respective institutions.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jacob J. Mandel
    • 1
  • Michael Youssef
    • 1
    • 7
  • Jooyeon Nam
    • 3
  • Akash J. Patel
    • 1
  • Ali Jalali
    • 1
  • Ethan B. Ludmir
    • 4
  • Diane Liu
    • 5
  • Jimin Wu
    • 5
  • Georgina Armstrong
    • 2
  • Jason Huse
    • 6
  • Melissa Bondy
    • 2
  • John F. de Groot
    • 7
    Email author
  1. 1.Department of Neurology and NeurosurgeryBaylor College of MedicineHoustonUSA
  2. 2.Department of MedicineBaylor College of MedicineHoustonUSA
  3. 3.Department of Neurological SciencesRush Medical CenterChicagoUSA
  4. 4.Division of Radiation Oncology – Unit 1422The University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  6. 6.Department of Translational Molecular PathologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  7. 7.Department of Neuro-OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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