The recent COVID-19 pandemic highlighted socioeconomic differences in health care access detrimental to the outcome, including a per capita excess mortality highest among the Black and Latino population. The prognostic role of socioeconomic factors for patients diagnosed with glioblastoma multiforme (GBM) has been hotly debated. GBM is the most common malignant primary brain tumor in adults and affects 3.3 percent of pediatric brain tumor patients. The disease has made headlines in recent years with the diagnosis of high-profile political figures such as President Biden’s son Beau Biden and the late Sens. Ted Kennedy and John McCain. Significant advances in surgical and adjuvant treatments for this disease have had a positive impact on short-term survival. Yet, there is a still-very-low five-year survival rate in adults, around 5.5 percent. As new therapeutic approaches develop, prolonging short-term survival coupled with high quality of life remains a priority when caring for patients with GBM.
Our medical predecessors named the deadliest brain tumor “glioblastoma multiforme” long before the field of molecular biology was established. Yet, they already recognized the complexity of this disease and its heterogeneity by calling it multiforme. We now know that its molecular features are numerous. Different “clusters” of cells with different molecular signatures pose a significant challenge in developing patient-specific therapies even within the same tumor. In addition to differences in each tumor’s molecular signature, other environmental factors might contribute to the speed of disease progression.
A recent study collected data from 28,952 patients diagnosed with GBM from the publicly available National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer registry. The authors found that socioeconomic status affected overall short-term survival, and patients with higher median household incomes had significantly higher short-term survival. Additionally, patients owning a private insurance plan had lower short-term mortality than those who were Medicaid recipients. When considering the ethnic background, Asian/Pacific Islander patients had the highest short-term survival. Black patients with GBM had the highest mortality due to non-GBM related causes, such as cardiac and stroke events.
The above study also corroborated that Non-Hispanic White (NHW) represented 80 percent of the patients affected by GBM, while they only represent 60 percent of the U.S. population. The higher incidence of GBM in the NHW population corroborates previous studies. Multiple factors can contribute to this discrepancy, including the possibility that this increased percentage is biased by health care access disparities. Other factors that may contribute to such discrepancy could be related to differences in tumor genetics, highlighted by the glioma genome-wide association study (GWAS).
Providing the best care to all patients regardless of ethnic background and socioeconomic status remains a high priority in all medical and surgical disciplines, including neuro-oncology. Moving forward, additional studies are needed to deepen our understanding of the impact on the outcomes of such factors. Further clarifying and identifying differences in health care access, socioeconomic factors, and racial diversities will allow us to develop new and more focused strategies to fight GBM and co-morbid non-GBM related causes of death in our patients.
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Isabelle M. Germano, MD, MBA, FAANS, FACS
The Mount Sinai Medical Center
New York, NY