Barriers to expeditious post-operative chemotherapy for patients with glioblastoma

Considerable effort has been dedicated to finding direct therapeutic treatments to improve prognosis for glioblastoma (GBM). Social determinants of health (SDoH) are known to affect the access patients have to obtaining specialist care. One such metric is the time to initiation of post-operative care, specifically timing to chemotherapy.

We conducted a retrospective analysis of patients with histopathologically confirmed GBM who received chemotherapy at our institution with complete follow-up. The primary outcome was time-to-chemotherapy initiation, and the cohort was divided into expeditious chemotherapy (within 28 days or less) or delayed chemotherapy (28 days or more). We evaluated the impact of race and ethnicity, insurance status (private, public, combination or none), and distance from the hospital, on the likelihood of patients receiving expeditious or delayed care. A mixture of Chi-square, Fisher's, and Mann-Whitney U tests, as well as adjusted multivariate analyses, were used to analyze statistical significance.

Across 124 patients, those with Medicare and Private secondary insurance had an increased likelihood of experiencing expeditious care (LR: χ²(5)= 11.75, p = 0.038). Multivariate regression analysis further re-affirmed this with finding (OR=0.339, 95 %CI:0.122-0.942, p = 0.039). Race/ethnicity and distance from the hospital both proved to be insignificant as predictors of expeditious and delayed care on univariate (p = 0.926, p = 0.801, respectively) and multivariate analyses (p = 0.593, p = 0.521, respectively).

Patients with primary Medicare alongside secondary Private insurance coverage had the highest likelihood of experiencing expeditious care in the post-operative period. None of the predictors predicted delayed care. We are reassured that neither race nor distance from hospital impact care significantly at our institution.