Top

Published in:

01-09-2018 | Clinical Study

Management of glioblastoma at safety-net hospitals

Authors: Michael G. Brandel, Robert C. Rennert, Christian Lopez Ramos, David R. Santiago-Dieppa, Jeffrey A. Steinberg, Reith R. Sarkar, Arvin R. Wali, J. Scott Pannell, James D. Murphy, Alexander A. Khalessi

Published in: Journal of Neuro-Oncology | Issue 2/2018

Abstract

Background

Safety-net hospitals (SNHs) provide disproportionate care for underserved patients. Prior studies have identified poor outcomes, increased costs, and reduced access to certain complex, elective surgeries at SNHs. However, it is unknown whether similar patterns exist for the management of glioblastoma (GBM). We sought to determine if patients treated at HBHs receive equitable care for GBM, and if safety-net burden status impacts post-treatment survival.

Methods

The National Cancer Database was queried for GBM patients diagnosed between 2010 and 2015. Safety-net burden was defined as the proportion of Medicaid and uninsured patients treated at each hospital, and stratified as low (LBH), medium (MBH), and high-burden (HBH) hospitals. The impact of safety-net burden on the receipt of any treatment, trimodality therapy, gross total resection (GTR), radiation, or chemotherapy was investigated. Secondary outcomes included post-treatment 30-day mortality, 90-day mortality, and overall survival. Univariate and multivariate analyses were utilized.

Results

Overall, 40,082 GBM patients at 1202 hospitals (352 LBHs, 553 MBHs, and 297 HBHs) were identified. Patients treated at HBHs were significantly less likely to receive trimodality therapy (OR = 0.75, p < 0.001), GTR (OR = 0.84, p < 0.001), radiation (OR = 0.73, p < 0.001), and chemotherapy (OR = 0.78, p < 0.001) than those treated at LBHs. Patients treated at HBHs had significantly increased 30-day (OR = 1.25, p = 0.031) and 90-day mortality (OR = 1.24, p = 0.001), and reduced overall survival (HR = 1.05, p = 0.039).

Conclusions

GBM patients treated at SNHs are less likely to receive standard-of-care therapies and have increased short- and long-term mortality. Additional research is needed to evaluate barriers to providing equitable care for GBM patients at SNHs.

Available only for authorised users

Lewin ME, Altman SH, Institute of Medicine (U.S.) Committee on the Changing Market Managed Care and the Future Viability of Safety Net Providers (2000) America’s health care safety net: intact but endangered. National Academy Press, Washington DC

Genther DJ, Gourin CG (2012) The effect of hospital safety-net burden status on short-term outcomes and cost of care after head and neck cancer surgery. Arch Otolaryngol Head Neck Surg 138:1015–1022. https://doi.org/10.1001/jamaoto.2013.611 CrossRefPubMed

Go DE, Abbott DE, Wima K, Hanseman DJ, Ertel AE, Chang AL, Shah SA, Hoehn RS (2016) Addressing the high costs of pancreaticoduodenectomy at safety-net hospitals. JAMA Surg 151:908–914. https://doi.org/10.1001/jamasurg.2016.1776 CrossRefPubMed

Hoehn RS, Wima K, Vestal MA, Weilage DJ, Hanseman DJ, Abbott DE, Shah SA (2016) Effect of hospital safety-net burden on cost and outcomes after surgery. JAMA Surg 151:120–128. https://doi.org/10.1001/jamasurg.2015.3209 CrossRefPubMed

Herrel LA, Ye Z, Miller DC (2015) Utilization and outcomes of inpatient urological care at safety net hospitals. J Urol 194:1380–1385. https://doi.org/10.1016/j.juro.2015.04.098 CrossRefPubMedPubMedCentral

Eslami MH, Rybin D, Doros G, Farber A (2014) Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals. J Vasc Surg 60:1627–1634. https://doi.org/10.1016/j.jvs.2014.08.055 CrossRefPubMed

Bradley CJ, Dahman B, Shickle LM, Lee W (2012) Surgery wait times and specialty services for insured and uninsured breast cancer patients: does hospital safety net status matter? Health Serv Res 47:677–697. https://doi.org/10.1111/j.1475-6773.2011.01328.x CrossRefPubMed

Virgo KS, Little AG, Fedewa SA, Chen AY, Flanders WD, Ward EM (2011) Safety-net burden hospitals and likelihood of curative-intent surgery for non-small cell lung cancer. J Am Coll Surg 213:633–643. https://doi.org/10.1016/j.jamcollsurg.2011.07.014 CrossRefPubMed

Ray S, Bonafede MM, Mohile NA (2014) Treatment patterns, survival, and healthcare costs of patients with malignant gliomas in a large US commercially insured population. Am Health Drug Benefits 7:140–149PubMedPubMedCentral

10.

Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO, European Organisation for R, Treatment of Cancer Brain T, Radiotherapy G, National Cancer Institute of Canada Clinical Trials G (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New Engl J Med 352: 987–996. https://doi.org/10.1056/NEJMoa043330 CrossRefPubMed

11.

Cagney DN, Alexander BM (2017) The cost and value of glioblastoma therapy. Expert Rev Anticancer Ther 17:657–659. https://doi.org/10.1080/14737140.2017.1351355 CrossRefPubMed

12.

Rhome R, Fisher R, Hormigo A, Parikh RR (2016) Disparities in receipt of modern concurrent chemoradiotherapy in glioblastoma. J Neuro-oncol 128:241–250. https://doi.org/10.1007/s11060-016-2101-5 CrossRef

13.

Curry WT Jr, Barker FG 2nd (2009) Racial, ethnic and socioeconomic disparities in the treatment of brain tumors. J Neuro-oncol 93:25–39. https://doi.org/10.1007/s11060-009-9840-5 CrossRef

14.

Mukherjee D, Zaidi HA, Kosztowski T, Chaichana KL, Brem H, Chang DC, Quinones-Hinojosa A (2010) Disparities in access to neuro-oncologic care in the United States. Arch Surg 145:247–253. https://doi.org/10.1001/archsurg.2009.288 CrossRefPubMed

15.

Aneja S, Khullar D, Yu JB (2013) The influence of regional health system characteristics on the surgical management and receipt of post operative radiation therapy for glioblastoma multiforme. J Neuro-oncol 112:393–401. https://doi.org/10.1007/s11060-013-1068-8 CrossRef

16.

Koshy M, Sher DJ, Spiotto M, Husain Z, Engelhard H, Slavin K, Nicholas MK, Weichselbaum RR, Rusthoven C (2017) Association between hospital volume and receipt of treatment and survival in patients with glioblastoma. J Neuro-oncol 135:529–534. https://doi.org/10.1007/s11060-017-2598-2 CrossRef

17.

Frandsen J, Orton A, Jensen R, Colman H, Cohen AL, Tward J, Shrieve DC, Suneja G (2017) Patterns of care and outcomes in gliosarcoma: an analysis of the National Cancer Database. J Neurosurg. https://doi.org/10.3171/2016.12.JNS162291 CrossRefPubMed

18.

Lurie N, Dubowitz T (2007) Health disparities and access to health. JAMA 297:1118–1121. https://doi.org/10.1001/jama.297.10.1118 CrossRefPubMed

19.

Fargen KM, Field RJ 3rd, Field RJ Jr (2007) Does rural Mississippi have access to emergency neurosurgical care? J Miss State Med Assoc 48:174–178PubMed

20.

Honeybul S, Neil-Dwyer G, Lees PD, Evans BT (1997) A nationwide study to investigate current opinion amongst maxillo-facial and neurological surgeons with regard to access surgery for neurosurgical procedures. Br J Neurosurg 11:405–410CrossRefPubMed

21.

Watts C, Adelstein W (1982) Access to neurosurgical care: a critical component of the manpower equation. Surg Neurol 17:223–226CrossRefPubMed

22.

Buckner JC, Ballman KV, Michalak JC, Burton GV, Cascino TL, Schomberg PJ, Hawkins RB, Scheithauer BW, Sandler HM, Marks RS, O’Fallon JR, North Central Cancer Treatment G, Southwest Oncology Group T (2006) Phase III trial of carmustine and cisplatin compared with carmustine alone and standard radiation therapy or accelerated radiation therapy in patients with glioblastoma multiforme: North Central Cancer Treatment Group 93-72-52 and Southwest Oncology Group 9503 Trials. J Clin Oncol 24: 3871–3879. https://doi.org/10.1200/JCO.2005.04.6979 CrossRefPubMed

23.

Halperin EC, Herndon J, Schold SC, Brown M, Vick N, Cairncross JG, Macdonald DR, Gaspar L, Fischer B, Dropcho E, Rosenfeld S, Morowitz R, Piepmeier J, Hait W, Byrne T, Salter M, Imperato J, Khandekar J, Paleologos N, Burger P, Bentel GC, Friedman A (1996) A phase III randomized prospective trial of external beam radiotherapy, mitomycin C, carmustine, and 6-mercaptopurine for the treatment of adults with anaplastic glioma of the brain. CNS Cancer Consortium. Int J Radiat Oncol Biol Phys 34:793–802CrossRefPubMed

24.

Schold SC Jr, Herndon JE, Burger PC, Halperin EC, Vick NA, Cairncross JG, Macdonald DR, Dropcho EJ, Morawetz R, Bigner DD et al (1993) Randomized comparison of diaziquone and carmustine in the treatment of adults with anaplastic glioma. J Clin Oncol 11:77–83. https://doi.org/10.1200/JCO.1993.11.1.77 CrossRefPubMed

25.

Stupp R, Taillibert S, Kanner AA, Kesari S, Steinberg DM, Toms SA, Taylor LP, Lieberman F, Silvani A, Fink KL, Barnett GH, Zhu JJ, Henson JW, Engelhard HH, Chen TC, Tran DD, Sroubek J, Tran ND, Hottinger AF, Landolfi J, Desai R, Caroli M, Kew Y, Honnorat J, Idbaih A, Kirson ED, Weinberg U, Palti Y, Hegi ME, Ram Z (2015) Maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for glioblastoma: a randomized clinical trial. JAMA 314:2535–2543. https://doi.org/10.1001/jama.2015.16669 CrossRefPubMed

26.

Cihoric N, Tsikkinis A, Minniti G, Lagerwaard FJ, Herrlinger U, Mathier E, Soldatovic I, Jeremic B, Ghadjar P, Elicin O, Lossl K, Aebersold DM, Belka C, Herrmann E, Niyazi M (2017) Current status and perspectives of interventional clinical trials for glioblastoma—analysis of ClinicalTrials.gov. Radiat Oncol 12:1. https://doi.org/10.1186/s13014-016-0740-5 CrossRefPubMedPubMedCentral

27.

Kumar A, Chandra PS, Sharma BS, Garg A, Rath GK, Bithal PK, Tripathi M (2014) The role of neuronavigation-guided functional MRI and diffusion tensor tractography along with cortical stimulation in patients with eloquent cortex lesions. Br J Neurosurg 28:226–233. https://doi.org/10.3109/02688697.2013.835370 CrossRefPubMed

28.

Sanai N, Berger MS (2010) Intraoperative stimulation techniques for functional pathway preservation and glioma resection. Neurosurg Focus 28:E1. https://doi.org/10.3171/2009.12.FOCUS09266 CrossRefPubMed

29.

Kubben PL, ter Meulen KJ, Schijns OE, ter Laak-Poort MP, van Overbeeke JJ, van Santbrink H (2011) Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review. Lancet Oncol 12:1062–1070. https://doi.org/10.1016/S1470-2045(11)70130-9 CrossRefPubMed

30.

Chen B, Wang H, Ge P, Zhao J, Li W, Gu H, Wang G, Luo Y, Chen D (2012) Gross total resection of glioma with the intraoperative fluorescence-guidance of fluorescein sodium. Int J Med Sci 9:708–714. https://doi.org/10.7150/ijms.4843 CrossRefPubMedPubMedCentral

31.

Hoehn RS, Go DE, Hanseman DJ, Shah SA, Paquette IM (2018) Hospital safety-net burden does not predict differences in rectal cancer treatment and outcomes. J Surg Res 221:204–210. https://doi.org/10.1016/j.jss.2017.08.047 CrossRefPubMed

32.

Dhar VK, Hoehn RS, Kim Y, Xia BT, Jung AD, Hanseman DJ, Ahmad SA, Shah SA (2017) Equivalent treatment and survival after resection of pancreatic cancer at safety-net hospitals. J Gastrointest Surg. https://doi.org/10.1007/s11605-017-3549-0 CrossRefPubMed

33.

Balasubramanian BA, Garcia MP, Corley DA, Doubeni CA, Haas JS, Kamineni A, Quinn VP, Wernli K, Zheng Y, Skinner CS (2017) Racial/ethnic differences in obesity and comorbidities between safety-net- and non safety-net integrated health systems. Medicine 96:e6326CrossRefPubMedPubMedCentral

34.

Dupree JM, Neimeyer J, McHugh M (2014) An advanced look at surgical performance under Medicare’s hospital-inpatient value-based purchasing program: who is winning and who is losing? J Am Coll Surg 218:1–7CrossRefPubMed

35.

Gilman M, Hockenberry JM, Adams EK, Milstein AS, Wilson IB, Becker ER (2015) the financial effect of value-based purchasing and the hospital readmissions reduction program on safety-net hospitals in 2014: a cohort study. Ann Intern Med 163:427–436CrossRefPubMed

36.

Lai PMR, Dasenbrock H, Lin N, Du R (2013) The impact of insurance status on the outcomes after aneurysmal subarachnoid hemorrhage. PLoS ONE 8:e78047CrossRefPubMedPubMedCentral

37.

Brodbelt A, Greenberg D, Winters T, Williams M, Vernon S, Collins VP, National Cancer Information Network Brain Tumour G (2015) Glioblastoma in England: 2007–2011. Eur J Cancer 51:533–542. https://doi.org/10.1016/j.ejca.2014.12.014 CrossRefPubMed

38.

Loureiro LVM, Pontes LdB, Callegaro-Filho D, Koch LDO, Weltman E, Victor EDS, Santos AJ, Borges LRR, Segreto RA, Malheiros SMF (2014) Initial care and outcome of glioblastoma multiforme patients in 2 diverse health care scenarios in Brazil: does public versus private health care matter? Neuro-oncology 16:999–1005CrossRefPubMedPubMedCentral

39.

Salem A, Hashem SA, Al-Rashdan A, Ezam N, Nour AA, Alsharbaji A, Sughayer M, Mohamad I, Elyan M, Addas AA, Al-Hussaini M, Almousa A (2011) The challenges of managing glioblastoma multiforme in developing countries: a trade-off between cost and quality of care. Hematol Oncol Stem Cell Ther 4:116–120CrossRefPubMed

Title: Management of glioblastoma at safety-net hospitals
Authors: Michael G. Brandel
Robert C. Rennert
Christian Lopez Ramos
David R. Santiago-Dieppa
Jeffrey A. Steinberg
Reith R. Sarkar
Arvin R. Wali
J. Scott Pannell
James D. Murphy
Alexander A. Khalessi
Publication date: 01-09-2018
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 2/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-2875-8

At a glance: The STEP trials

Springer Medicine

Management of glioblastoma at safety-net hospitals

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors

Prediction of survival in patients affected by glioblastoma: histogram analysis of perfusion MRI

Virus vector-mediated genetic modification of brain tumor stromal cells after intravenous delivery

Contrast enhancement predicting survival in integrated molecular subtypes of diffuse glioma: an observational cohort study

GOLPH3 promotes glioma progression via facilitating JAK2–STAT3 pathway activation

Cranial nerve outcomes after primary stereotactic radiosurgery for symptomatic skull base meningiomas