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Socioeconomic Status and Short-term Glioblastoma Survival: Does it Make a Difference?

By Brain Tumor, Tumor, Tumor SeriesNo Comments

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.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NSTumorSection and using the hashtag #TumorSeries.

Isabelle M. Germano, MD, MBA, FAANS, FACS
The Mount Sinai Medical Center
New York, NY

March 11, 2022
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Introduction to Tumor Focus Series: Bringing “Better” to Our Patients in Multiple Ways

By Tumor, Tumor SeriesNo Comments

Neurosurgery has historically been a uniquely wide-ranging and varied specialty. Unlike other specialties that focus on a particular organ system or body region, neurosurgery is quite literally a “head-to-toe” specialty dealing with the brain, spinal cord, peripheral nerves and the other organs intimately related to the nervous system. Neurosurgeons classically had to be experts in a wide variety of surgical procedures and disease processes. As medical knowledge and technology have advanced, neurosurgeons have evolved with medicine to become experts in particular disease processes, leading to a reorganization of neurosurgery into sub-specialty disciplines.

Over the years, the Neurosurgery Blog has partnered with various neurosurgery subspecialty sections to provide an update on the state of the subspecialty, highlight current issues, add to the conversation and portray their concerns to a non-specialized audience. Today’s neurosurgeon must be facile in many different areas — both medical and non-medical. As medical care and health care delivery have grown increasingly complex, neurosurgeons must wear several hats: surgeon, team-member in multi-disciplinary care teams, teacher, scientist and advocate.

We partnered with the AANS/CNS Joint Section on Tumors for the following series of blogs. Under the guidance of Tumor Section chair, Jason P. Sheehan, MD, PhD, FAANS, and AANS/CNS Washington Committee representative, Michael A. Vogelbaum, MD, PhD, FAANS, members of the section came together and produced a sweeping overview of ongoing topics:

  • Arnold B. Etame, MD, FAANS, leads us off with a piece about diversity in neurosurgical oncology. Isabelle M. Germano, MD, FAANS, FACS, then tackles disparities in access to care and outcomes in brain tumor patients.
  • Ricardo J. Komotar, MD, FAANS, FACS, reports on efforts in education and collaboration on an international scale. Edjah E. Nduom, MD, FAANS, speaks to brain tumor advocacy, providing an overview of the outward-looking direction of some of our efforts.
  • Michael Lim, MD, FAANS, and Nader Sanai, MD, FAANS, bring us two pieces highlighting the ability of neurosurgeons to translate discoveries from the lab into patient care and back again and how neurosurgeons contribute to drug development in the increasingly complex fight against brain tumors. These pieces are complemented by an article by Manish K. Aghi, MD, PhD, FAANS, updating the role of neurosurgeons in clinical trials and research in neurosurgical oncology.

Academic publishing, the Journal of Neuro-Oncology, and the dissemination of scientific results, particularly in the era of the COVID-19 pandemic, are at the center of a piece by Dr. Sheehan and Christopher P. Cifarelli, MD, PhD, MMM, FAANS, FACS. Dr. Vogelbaum presents “A Neurosurgical Perspective on Multidisciplinary Care for Patients with Brain Tumors,” emphasizing the team-based nature of neuro-oncology care today.

In the era of a worldwide pandemic and an increasingly complex care delivery environment, neurosurgeons are playing more and more roles in delivering better care to our patients. This is especially true in the field of neurooncology. We hope that these blogs inspire you to join the efforts of this important field. The amount of work that the members of the section and the authors, in particular, put into these issues outside of patient care is astonishing and deserves credit!

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NSTumorSection and using the hashtag #TumorSeries.

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, Pa.

January 20, 2022
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