Rural medical disparities in multimodal glioblastoma treatment

Glioblastoma continues to have a poor prognosis, although recent advancements in multimodal treatments have gradually improved outcomes. However, treatment options have become increasingly complex and highly specialized. In rural areas, patients often travel long distances for treatments such as bevacizumab (BEV) administration, which may hinder treatment adherence and potentially lead to poorer outcomes. This study analyzed the impact of commuting distance on survival using clinical data from the Kyushu Neuro-Oncology Study Group. We measured the commuting distances of 564 patients with glioblastoma who were initially treated at 11 participating institutions between 2010 and 2023. Patients were categorized into nearby and remote groups using a threshold of 20 km, and their overall survival (OS) was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model, incorporating additional potential prognostic factors. In the overall cohort, there was no significant difference in OS between the nearby and remote groups (median OS: 19.2 vs. 18.3 months). However, among the 452 patients who underwent second-line treatment for recurrence, OS was significantly longer in the nearby group (median OS: 18.7 vs. 16.8 months). Univariate analysis revealed that commuting distance (P = 0.037), age, extent of resection, and performance status (PS) were all significant prognostic factors. Multivariate analysis demonstrated that commuting distance was an independent prognostic factor (P = 0.009). These results were validated through propensity score matching, which analyzed 148 patients in each group (median OS: 19.3 vs. 16.4 months). Our findings suggest that commuting distance is associated with prognosis in glioblastoma patients who require second-line treatment. To address this issue, it is necessary to establish an environment that enables the smooth and continuous delivery of multimodal treatment, particularly in rural areas.