Effect of health disparities on overall survival of patients with glioblastoma

J Neurooncol. 2019 Apr;142(2):365-374. doi: 10.1007/s11060-019-03108-z. Epub 2019 Jan 22.


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

Methods: 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).

Results: 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.

Conclusions: 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.

Keywords: Glioblastoma; Health disparities; Insurance; Overall survival; Race.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Neoplasms / epidemiology*
  • Brain Neoplasms / therapy*
  • Female
  • Glioblastoma / epidemiology*
  • Glioblastoma / therapy*
  • Healthcare Disparities*
  • Humans
  • Insurance, Health
  • Karnofsky Performance Status
  • Male
  • Middle Aged
  • Prognosis
  • Racial Groups
  • Retrospective Studies
  • Socioeconomic Factors
  • Survival Analysis
  • Young Adult