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Treatment, healthcare utilization and outcomes in patients with glioblastoma in Ontario: a 10-year cohort study

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Abstract

Background and purpose

Glioblastoma (GBM) is the most common malignant primary brain tumour in adults. Receipt of adjuvant therapies has been shown to exert a significant positive effect on patient survival. Little is known however about how changes in standards of care and healthcare system factors, such as access, affect real-world outcomes. In this study, we provide an overview of GBM in Ontario and examine elements of care, including treatment patterns, healthcare utilization, and overall survival, from 2010 to 2019, to interpret the impact of the changes in practice standards and expansion of the care network within this period.

Methods

Using linked health-administrative databases from Ontario, Canada, we conducted a population-based cohort study to examine the clinical and biological characteristics, treatment, and healthcare utilization patterns of adult GBM patients diagnosed between 2010 and 2019. The primary outcomes were enrollment in adjuvant chemoradiation treatment and 1-, 2-, and 5-year survival. All analyses were performed using the Statistical Analysis Software (SAS).

Results

5392 patients were diagnosed with GBM in Ontario from 2010 to 2019 (58% male, 42% female). The median age at diagnosis was 64. Receipt of adjuvant chemoradiation within one year of diagnosis increased from 51% in 2010 to 63% in 2019. 1-year, 2-year, and 5-year overall survival for all patients remained stable, ranging between 40 and 43%, 15–19%, and 5–7%, respectively. For patients above the age of 65, however, 1-year survival increased from 19% in 2010 to 26% in 2019.

Interpretation

Regionalization enabled access to treatment closer to home for many patients. Over the last decade, receipt of adjuvant chemoradiation increased among elderly patients, but the improvement in 1-year overall survival over time was accounted for by sociodemographic and clinical covariates. Our findings support the efforts for regionalization of services to improve accessibility.

Conclusion

This Ontario-based study provides insight into the effect of practice evolution and healthcare utilization on the overall survival of patients with GBM. Overall survival for most patients with glioblastoma has remained stagnant over the past decade. Changes in treatment standards and expansion of access to treating centres have been associated with prolonged survival in elderly glioblastoma patients.

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Data availability

The data used for this study, derived from provincial health administrative databases and patient registries, are subject to privacy regulations. Efforts have been made to ensure the availability of anonymized datasets for research purposes, subject to compliance with relevant privacy laws and regulations. Requests for access to the data can be directed to the corresponding author for consideration. Summary statistics and aggregated findings will be made available in the published manuscript to facilitate transparency and reproducibility of the study's results.

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Funding

KR is supported by the Ontario Graduate Scholarship. SD is supported by an Early Researcher Award from the Province of Ontario and the Keenan Chair in Surgery.

Author information

Author notes

  1. Kathryn Rzadki and Steven Habbous contributed equally to this work.

Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Wafa Baqri & Sunit Das

  2. Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Kathryn Rzadki & Sunit Das

  3. Ontario Health (Cancer Care Ontario), Toronto, ON, Canada

    Steven Habbous & Sunit Das

  4. Epidemiology & Biostatistics, Western University, London, ON, Canada

    Steven Habbous

  5. Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada

    Sunit Das

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  1. Wafa Baqri
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Contributions

K.R. and S.H. developed and carried out the experiment. S.H. developed the figures. K.R. and W.B. developed the manuscript. S.D. supervised the findings of this work. W.B., S.H. and S.D. revised and reviewed the manuscript.

Corresponding author

Correspondence to Sunit Das.

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Ethical approval

This work was undertaken at OH(CCO), under the aegis of quality improvement. REB approval was obtained through Clinical Trials Ontario to allow student involvement in the work (CTO Project ID: 139; Identifying barriers to completion of adjuvant therapy in patients with newly diagnosed glioblastoma multiforme: an exploratory study).

Conflict of interest

Sunit Das serves as the Provincial Lead for CNS Oncology at Ontario Health (Cancer Care Ontario).

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Baqri, W., Rzadki, K., Habbous, S. et al. Treatment, healthcare utilization and outcomes in patients with glioblastoma in Ontario: a 10-year cohort study. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04690-7

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