Introduction: Glioblastoma(GBM) is an aggressive brain malignancy with dismal survival, yet with significant heterogeneity in outcomes. While access to healthcare impacts prognosis in several malignancies, this question remains incompletely answered in GBM.

Methods: Retrospective analysis of 354 GBM patients that underwent first resection at our institution(2007-2015).

Results: Of the 354 patients (median age=61; females=37.6%), 32 (9.0%) had no insurance, while 322 (91.0%) had insurance of which 131 (37.0%) had Medicare, 45 (12.7%) had Medicaid and 146 (41.2%) had private insurance. On average, insured patients survived almost 2-fold longer(p=0.007) than those that were uninsured, while differences between specific insurance types did not influence survival. The adjusted hazard of death was higher in uninsured patients (HR=2.27[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 disparity in PCP status with none of the uninsured and 72% of insured patients having PCPs. Postoperative adjuvant treatment rates with temozolomide and radiation therapy(XRT) were significantly less in uninsured (temozolomide=56.3%;XRT=56.3%) than insured (temozolomide=75.9%;XRT=80.1%,p=0.005) patients. Insured patients receiving both agents had better prognosis than uninsured patients receiving the same (9.1 vs 16.34 months,p=0.025), suggesting that improved survival in insured patients could only partly be explained by higher treatment rates. Moreover, having a PCP improved survival among the insured cohort (10.7 vs 16.1 months;HR=1.65[1.27-2.15],p=0.0003), which could be explained by differences in tumor diameter at diagnosis (4.3 vs 4.8 cm,p=0.003) and higher clinical trial enrollment in patients with PCPs versus those without, suggesting a critical role of PCPs for a timelier diagnosis of GBM and access to innovative therapies.

Conclusions: Access to healthcare is a strong determinant of prognosis in newly diagnosed GBM. Lack of health insurance and PCP coverage are major challenges within our healthcare system, which, if improved upon, could favorably impact the prognosis of GBM patients.

Patient Care: Findings from our study will enable healthcare providers to stratify GBM patients into ‘highly vulnerable’ and ‘less vulnerable’ to poorer survival outcomes based on their insurance and PCP status. By understanding the mechanisms leading to poorer survival outcomes in uninsured patients and those patients without PCPs, as reported in our study, healthcare providers can make an actionable difference by addressing those needs to improve survival outcomes in these vulnerable patient populations.

Learning Objectives: By the conclusion of this session, participants should be able to (1) Understand the effects of disparities in healthcare on survival outcomes in GBM patients. (2) Identify healthcare-related factors associated with poorer prognosis in GBM patients with limited access to healthcare, and (3)Discuss mechanisms leading to poorer survival outcomes in patients without insurance and those without PCPs.

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