Influence of insurance status on survival of adults with glioblastoma multiforme: A population‐based study

Rong, Xiaoming; Yang, Wuyang; Garzón-Muvdi, Tomás; Caplan, Justin M.; Hui, Xuan; Lim, Michael; Huang, Judy

doi:10.1002/cncr.30160

Cited by 54 publications

(64 citation statements)

References 48 publications

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“…In a population-based study by Rong et al, using the SEER database, the authors found that patients with non-Medicaid insurance had a longer median overall survival, whereas those with Medicaid or no insurance did not have this survival benefit. 26 In our study we found similar results to that of Rong et al, with our insured patient cohort having a median overall survival that was almost twice as long when compared to survival of uninsured patients. However, unlike the findings by Rong et al, in our study there was no statistical significance in the median overall survival among the Medicaid, Medicare, and private insurance groups, which could potentially reflect greater equality between these coverages in our regional market compared to the diverse states that comprise the SEER database.…”

Section: Discussionsupporting

confidence: 91%

“…Consistent with the literature, our cohort comprised 9.04% uninsured patients, 12.7% with Medicaid, 37.01% with Medicare, and 41.24% with private insurance. 22,26 In this single-institution study, we found insurance status, one of the many indicators of access to health care, to be a major prognostic factor for patients with newly diagnosed GBM, consistent with the findings in a recent study by Rong et al 26 in which a large population cancer registry was used.…”

Section: Discussionsupporting

confidence: 89%

“…10,15,19,26 In the same multivariate model, treatment with both TMZ and XRT (HR 0.60 [95% CI 0.45–0.81, p = 0.001) and postoperative clinical trial enrollment (HR 0.54 [95% CI 0.41–0.71, p < 0.0001) were independent predictors of improved overall survival in our patient cohort.…”

Section: Resultsmentioning

confidence: 64%

“…4,26 Tumor size is just one marker of disease burden, and our retrospective study did not fully capture other metrics such as Karnofsky Performance Scale score. However, the impact of access to health care on neurological diseases and survival outcomes has been supported by several other studies, corroborating our findings.…”

Section: Discussionmentioning

confidence: 99%

“…To date, 2 studies have found an association between insurance status and prognosis in patients with GBM; however, these studies were based on the Surveillance, Epidemiology, and End Results (SEER) Program database and the National Cancer Database and could not define patient-based factors that could explain disparities in outcomes. 22,26 However, no studies to date have explored the impact of PCP status on GBM prognosis.…”

mentioning

confidence: 99%

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Disparities in health care determine prognosis in newly diagnosed glioblastoma

Chandra¹,

Rick²,

Ore³

et al. 2018

Neurosurgical Focus

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OBJECTIVEGlioblastoma (GBM) is an aggressive brain malignancy with a short overall patient survival, yet there remains significant heterogeneity in outcomes. Although access to health care has previously been linked to impact on prognosis in several malignancies, this question remains incompletely answered in GBM.METHODSThis study was a retrospective analysis of 354 newly diagnosed patients with GBM who underwent first resection at the authors’ institution (2007–2015).RESULTSOf the 354 patients (median age 61 years, and 37.6% were females), 32 (9.0%) had no insurance, whereas 322 (91.0%) had insurance, of whom 131 (40.7%) had Medicare, 45 (14%) had Medicaid, and 146 (45.3%) had private insurance. On average, insured patients survived almost 2-fold longer (p < 0.0001) than those who were uninsured, whereas differences between specific insurance types did not influence survival. The adjusted hazard ratio (HR) for death was higher in uninsured patients (HR 2.27 [95% CI 1.49–3.33], p = 0.0003). Age, mean household income, tumor size at diagnosis, and extent of resection did not differ between insured and uninsured patients, but there was a disparity in primary care physician (PCP) status—none of the uninsured patients had PCPs, whereas 72% of insured patients had PCPs. Postoperative adjuvant treatment rates with temozolomide (TMZ) and radiation therapy (XRT) were significantly less in uninsured (TMZ in 56.3%, XRT in 56.3%) than in insured (TMZ in 75.2%, XRT in 79.2%; p = 0.02 and p = 0.003) patients. Insured patients receiving both agents had better prognosis than uninsured patients receiving the same treatment (9.1 vs 16.34 months; p = 0.025), suggesting that the survival effect in insured patients could only partly be explained by higher treatment rates. Moreover, having a PCP increased survival among the insured cohort (10.7 vs 16.1 months, HR 1.65 [95% CI 1.27–2.15]; p = 0.0001), which could be explained by significant differences in tumor diameter at initial diagnosis between patients with and without PCPs (4.3 vs 4.8 cm, p = 0.003), and a higher rate of clinical trial enrollment, suggesting a critical role of PCPs for a timelier diagnosis of GBM and proactive cancer care management.CONCLUSIONSAccess to health care is a strong determinant of prognosis in newly diagnosed patients with GBM. Any type of insurance coverage and having a PCP improved prognosis in this patient cohort. Higher rates of treatment with TMZ plus XRT, clinical trial enrollment, fewer comorbidities, and early diagnosis may explain survival disparities. Lack of health insurance or a PCP are major challenges within the health care system, which, if improved upon, could favorably impact the prognosis of patients with GBM.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Disparities in health care determine prognosis in newly diagnosed glioblastoma

Chandra¹,

Rick²,

Ore³

et al. 2018

Neurosurgical Focus

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Association between giant cell glioblastoma and glioblastoma multiforme in the United States: A retrospective cohort study

Abdulrahman

Bukhari

et al. 2019

Brain and Behavior

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Objectives The current study aims to find the differences between glioblastoma multiforme (GBM) and giant cell glioblastoma (GCG) regarding mortality and prognosis among adults and elderly patients in the U.S. Methods and Materials This study is a historical cohort type of study and is conducted on adults and elderly individuals with GBM or GCG from the years 1985–2014 in the U.S. Data were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. The study exposure was GBM or GCG and the outcome was mortality. The potential confounders were age, sex, race, ethnicity, year of diagnosis, primary site, brain overlap, and surgery. A chi‐square test was used for categorical data. A univariate analysis was used for variables having a p‐value <.05. Potential confounders were selected and evaluated using multivariate logistic regression models to calculate the odds ratio with stepwise selection. Results The study sample was 25,117. The incidences of GBM and GCG were not similar in relation to age group. Also, Spanish–Hispanic ethnicity was independently protective of GBM and GCG as compared to Non‐Spanish–Hispanic ethnicity patients with GBM have a higher mortality rate than do GCG patients. The mortality rate was higher among patients diagnosed before 2010. Conclusion GCG was not statistically significant in association to reduced mortality. Non‐Spanish–Hispanics with GBM or GCG had a higher mortality rate than did Spanish–Hispanics. Factors such as being female, being age 59–65, and having a year of diagnosis before 2010 were independently associated with increased mortality.

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Population‐based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease

et al. 2018

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To investigate the interrelation between economic, marital, and known histopathologic/therapeutic prognostic factors in presentation and survival of patients with lung cancer in nine different ethnic groups. A retrospective review of the SEER database was conducted through the years 2007–2012. Population differences were assessed via chi‐square testing. Multivariable analyses (MVA) were used to detect overall survival (OS) differences in the total population (TP, N = 153,027) and for those patients presenting with Stage IV (N = 70,968). Compared to Whites, Blacks were more likely to present with younger age, male sex, lower income, no insurance, single/widowed partnership, less squamous cell carcinomas, and advanced stage; and experience less definitive surgery, lower OS, and lung cancer‐specific (LCSS) survival. White Hispanics presented with younger age, higher income, lower rates of insurance, single/widowed partnership status, advanced stage, more adenocarcinomas, and lower rates of definitive surgery, but no difference in OS and LCSS than Whites. In the TP and Stage IV populations, MVAs revealed that OS was better or equivalent to Whites for all other ethnic groups and was positively associated with insurance, marriage, and higher income. Blacks presented with more advanced disease and were more likely to succumb to lung cancer, but when adjusted for prognostic factors, they had a better OS in the TP compared to Whites. Disparities in income, marital status, and insurance rather than race affect OS of patients with lung cancer. Because of their presentation with advanced disease, Black and Hispanics are likely to have increased benefit from lung cancer screening.

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Influence of insurance status on survival of adults with glioblastoma multiforme: A population‐based study

Abstract: Variations existed in insurance status within the GBM population. Uninsured status and Medicaid insurance suggested shorter survival compared with non-Medicaid insurance among a population of patients with GBM. Cancer 2016;122:3157-65. © 2016 American Cancer Society.

Cited by 54 publications

References 48 publications

Disparities in health care determine prognosis in newly diagnosed glioblastoma

Disparities in health care determine prognosis in newly diagnosed glioblastoma

Association between giant cell glioblastoma and glioblastoma multiforme in the United States: A retrospective cohort study

Population‐based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease

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