Insurance correlates with improved access to care and outcome among glioblastoma patients

Desmond A. Brown, Benjamin T. Himes, Panagiotis Kerezoudis, Yirengah M. Chilinda-Salter, Sanjeet S. Grewal, Joshua A. Spear, Mohamad Bydon, Terry C. Burns, Ian F. Parney

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background. The current standard of care for glioblastoma (GBM) constitutes maximal safe surgical resection, followed by fractionated radiation and temozolomide. This treatment regimen is logistically burdensome, and in a health care system in which access to care is variable, there may be patients with worsened outcomes due to inadequate access to optimal treatment. Methods. The National Cancer Database was queried for patients with diagnoses of GBM in 2006-2014. Patients were grouped according to insurance status: private insurance, Medicare, Medicaid, or uninsured. Treatments provided (surgery, radiation, and chemotherapy) were compared between groups in univariate and multivariable logistic regression analysis. Results. A total of 61 614 patients were analyzed. Compared with private insurance, the odds of surgery for Medicaid and uninsured patients were 0.72 (95% CI: 0.66-0.79) and 0.77 (95% CI: 0.69-0.87), respectively (P < 0.001). The multivariable odds of receiving radiotherapy were 0.91 (95% CI: 0.86-0.96), 0.62 (95% CI: 0.57-0.68), and 0.47 (95% CI: 0.43-0.52) for Medicare, Medicaid, and uninsured patients, respectively (all P < 0.001). In addition, the odds of receiving chemotherapy were 0.94 (95% CI: 0.89-0.99), 0.53 (95% CI: 0.49-0.57), and 0.41 (95% CI: 0.38-0.46) for Medicare, Medicaid, and uninsured patients, respectively (all P < 0.001). Conclusion. Insurance status and type of insurance coverage appear to impact treatments rendered for GBM, independently of other variables. Furthermore, we find that such differential access to care significantly impacts survival. Ensuring adequate access to care for all patients with diagnoses of glioblastoma is critical to optimize survival, especially as therapies continue to advance.

Original languageEnglish (US)
Pages (from-to)1374-1382
Number of pages9
JournalNeuro-oncology
Volume20
Issue number10
DOIs
StatePublished - Sep 3 2018

Keywords

  • Glioblastoma
  • Health care access
  • Insurance
  • Medicaid
  • Medicare

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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