Insurance Correlates with Improved Access to Care and Outcome Among Glioblastoma Patients

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 healthcare 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 diagnosed with 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 to private insurance, the odds of surgery for Medicaid and uninsured patients were 0.72 (95% C.I. 0.66-0.79) and 0.77 (95% C.I. 0.69-0.87), respectively (p< .001). The multivariable odds of receiving radiotherapy were 0.91 (95% C.I. 0.86-0.96), 0.62 (95% C.I. 0.57-0.68) and 0.47 (95% C.I. 0.43-0.52) for Medicare, Medicaid, and uninsured patients, respectively (all p < .001). In addition, the odds of receiving chemotherapy were 0.94 (95% C.I. 0.89-0.99), 0.53 (95% C.I. 0.49-0.57), and 0.41 (95% C.I. 0.38-0.46) for Medicare, Medicaid, and uninsured patients, respectively (all p < .001).

Conclusion

Insurance status and type of insurance coverage appears to impact treatments rendered for GBM, independent of other variables. Furthermore, we find that such differential access to care significantly impacts survival. Ensuring adequate access to care for all patients diagnosed with glioblastoma is critical to optimize survival, especially as therapies continue to advance.