Implications of Demographic and Socioeconomic Factors on Treatment Delays and Overall Survival in Patients with High-Grade Primary Brain Tumors

Introduction: The conventional treatment for high-grade primary brain tumors involves a combination of surgery, chemotherapy, and radiotherapy. Despite documented demographic and socioeconomic disparities in tumor outcomes, the underlying causes remain unclear. The objective of the present study is to study the effects of demographic and socioeconomic status on overall survival in high-grade primary brain tumors.

Methods: This retrospective study analyzed data from 36,739 patients ages 18 and over diagnosed with grade III-IV primary CNS tumors in the National Cancer Database between 2011 and 2017. This study investigated delays (>7 days) in surgery, (>21 days) in radiotherapy, and (>21 days) in chemotherapy. Factors studied included age, sex, race, insurance status, distance to treatment center, household income, and education. Statistical analyses were performed on Statistical Analysis Software (SAS) and consisted of univariate and multivariate regressions, along with Cox regressions, to identify associations between these factors and treatment modalities.

Results: Analyses indicated that Age, distance to the treatment facility, and type of facility significantly influenced delays in all three treatment modalities. Uninsured status was significantly associated with delays in chemotherapy (p=0.0411) and radiation (p=0.0022) but led to shorter delays in surgery (p=0.0063). While race did not significantly impact treatment delays based on multiple univariate regression analyses, identifying as white was associated with decreased overall survival (HR=1.228; p=0.0041). Adjusting for socioeconomic and demographic factors, increased time to radiation (HR=0.997; p< 0.0001) and chemotherapy (HR=0.998; p< 0.0001) was linked to better overall survival. Interestingly, delays in surgery did not significantly affect overall survival.

Conclusion : This study indicates that while socioeconomic and demographic factors are associated with delays in treatment for high-grade primary CNS tumors, these delays do not appear to be associated with differences in overall survival rates. These findings underscore the need for further research to explore variables beyond demographics and socioeconomic factors that might influence differences in overall survival.