Effect of health disparities on overall survival of patients with glioblastoma
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.
KeywordsHealth disparities Race Glioblastoma Insurance Overall survival
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.
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.
- 3.Polite BN, Adams-Campbell LL, Brawley OW et al (2017) Charting the future of cancer health disparities research: a position statement from the American Association for Cancer Research, the American CANCER SOCIETY, the American Society of Clinical Oncology, and the National Cancer Institute. J Clin Oncol 35(26):3075–3082CrossRefPubMedGoogle Scholar
- 4.National Institutes of Health. Cancer health disparities. cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet#q1.Google Scholar
- 17.Mahal AR, Mahal BA, Nguyen PL, Yu JB. Prostate cancer outcomes for men aged younger than 65 years with medicaid versus private insurance. Cancer 124(4):752–759Google Scholar
- 21.Brown DA, Himes BT, Kerezoudis P et al (2018) Insurance correlates with improved access to care and outcome among glioblastoma patients. Neuro-oncologyGoogle Scholar
- 22.Ellis L, Canchola AJ, Spiegel D, Ladabaum U, Haile R, Gomez SL. (2017) Trends in cancer survival by health insurance status in California from 1997 to 2014. JAMA Oncol 4(3):317–323Google Scholar
- 23.Soni A, Sabik LM, Simon K, Sommers BD. (2017) Changes in insurance coverage among cancer patients under the affordable care act. JAMA Oncol 4(1):122–124Google Scholar
- 35.Mandel JJ, Yust-Katz S, Patel AJ et al (2017) Inability of positive phase II clinical trials of investigational treatments to subsequently predict positive phase III clinical trials in glioblastoma. Neuro-oncology 20(1):113–122Google Scholar