Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota.
Neuro Oncol. 2018 Sep 3;20(10):1374-1382. doi: 10.1093/neuonc/noy102.
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.
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.
A total of 61614 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).
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.
胶质母细胞瘤（GBM）的现行标准治疗包括最大限度的安全手术切除，随后进行分割放疗和替莫唑胺化疗。这种治疗方案在后勤方面负担沉重，而且在医疗保健系统中，获得治疗的机会各不相同，因此可能会有患者由于无法获得最佳治疗而导致预后恶化。
从 2006 年至 2014 年，国家癌症数据库中查询诊断为 GBM 的患者。根据保险状况将患者分为私人保险、医疗保险、医疗补助或无保险。在单变量和多变量逻辑回归分析中比较各组之间提供的治疗（手术、放疗和化疗）。
共分析了 61614 例患者。与私人保险相比，医疗补助和无保险患者手术的可能性分别为 0.72（95%CI：0.66-0.79）和 0.77（95%CI：0.69-0.87）（均 P <0.001）。接受放疗的多变量可能性分别为医疗保险、医疗补助和无保险患者的 0.91（95%CI：0.86-0.96）、0.62（95%CI：0.57-0.68）和 0.47（95%CI：0.43-0.52）（均 P <0.001）。此外，接受化疗的可能性分别为医疗保险、医疗补助和无保险患者的 0.94（95%CI：0.89-0.99）、0.53（95%CI：0.49-0.57）和 0.41（95%CI：0.38-0.46）（均 P <0.001）。
保险状况和保险类型似乎独立于其他变量影响 GBM 的治疗效果。此外，我们发现这种获得护理的差异显著影响生存。确保所有诊断为胶质母细胞瘤的患者都能获得足够的护理是优化生存的关键，尤其是随着治疗的不断进步。
