Introduction: 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 multivariable analyses were utilized.
Results: Overall, 40,082 GBM patients at 1,202 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: Glioblastoma 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.
Patient Care: These findings may impact health policy and bring to the forefront a contributor to healthcare disparities in the field of neuro-oncology.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the potential impact of safety net status on a hospital's ability to provide care, 2) Discuss, in small groups, disparities observed for glioblastoma patients treated at hospitals with different levels of safety-net burden, and 3) Consider potential mechanisms by which this disparity may be addressed at the hospital level and the public policy level.