Geographic and socioeconomic considerations for glioblastoma treatment in the elderly at a national level: a US perspective

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.

Keywords: access; disparity; elderly; geographic; glioblastoma.

Figure 1.

Kaplan-Meier plots of overall survival within the elderly cohort treated with A, vs without triple therapy (11.7 vs 4.6 months; log-rank P < .01); B, resection (8.5 vs 5.4 months; log-rank P < .01); C, radiation therapy (10.1 vs 2.9 months; log-rank P < .01); and D, chemotherapy (10.7 vs 3.3 months; log-rank P < .01).

Figure 2.

Heat map of significant odds ratios for treatment calculated comparing elderly to nonelderly cohorts for A, triple therapy; B, resection; C, radiation therapy; and D, chemotherapy. Regions with significant ratios are outlined in red.