Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Socioeconomic factors in high-grade glioma treatment and outcomes: A systematic and narrative review of a heterogeneous evidence Base.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Weerasekara Pumudu, Damsinghe Chayu, Perera Sunil Lakshman
Аннотация
INTRODUCTION: High-Grade Gliomas (HGGs), including glioblastomas (GBM), are aggressive brain tumors with a 5-year survival rate of 7.2% with little understanding on the socioeconomic impact on outcomes. This study aimed to examine how socioeconomic factors of patients and healthcare providers impact treatment choices and outcomes in HGG management through a narrative and manual approach to data collection and synthesis, as a precursor to a systematic review and analysis that will quantitatively approach the question.
METHODS: The study initially intended as a meta-analysis based on a literature search performed across MEDLINE, PubMed, and EMBASE using predefined terms was converted to a narrative review in view of the substantial heterogeneity in both socio-economic status (SES) definitions and outcome reporting.
RESULTS AND DISCUSSION: A review of 15 out of 261 studies identified 16 SES variable-outcome combinations, namely income (n = 7), a Socioeconomic Status Index (SES index; n = 6), an Area Deprivation Index (ADI; n = 2), and a Frailty Index (n = 1). Median hazard ratio was 0.760 (n = 11), overall survival ranged from 4 - 8.16 months (mean = 5.52 months; n = 4), and incidence ratios > 1 (n = 2); all favoring higher SES groups. Further narrative analysis showcases nuance in the results with survival differences disappearing in longer time frames. The indication of early diagnosis in higher SES categories could also imply that better survival is instead driven by earlier diagnosis rather than a direct impact onto disease progression. Regardless, this overall infers that the SES impacts are limited to a short period of time without affecting eventual prognosis in a meaningful manner.
CONCLUSION: These findings, based off a limited set of studies, suggest that there is at least a temporary impact of SES differences onto varied dimensions of HGG treatment and outcomes. Reducing effects with time also suggests that these SES differences might have significant implications for palliative care and quality of life care during HGG treatment protocols. Given limited exploration especially outside of HGGs, further studies that investigate more detail onto SES are warranted, particularly in the dimensions of early-diagnosis and palliative care.
METHODS: The study initially intended as a meta-analysis based on a literature search performed across MEDLINE, PubMed, and EMBASE using predefined terms was converted to a narrative review in view of the substantial heterogeneity in both socio-economic status (SES) definitions and outcome reporting.
RESULTS AND DISCUSSION: A review of 15 out of 261 studies identified 16 SES variable-outcome combinations, namely income (n = 7), a Socioeconomic Status Index (SES index; n = 6), an Area Deprivation Index (ADI; n = 2), and a Frailty Index (n = 1). Median hazard ratio was 0.760 (n = 11), overall survival ranged from 4 - 8.16 months (mean = 5.52 months; n = 4), and incidence ratios > 1 (n = 2); all favoring higher SES groups. Further narrative analysis showcases nuance in the results with survival differences disappearing in longer time frames. The indication of early diagnosis in higher SES categories could also imply that better survival is instead driven by earlier diagnosis rather than a direct impact onto disease progression. Regardless, this overall infers that the SES impacts are limited to a short period of time without affecting eventual prognosis in a meaningful manner.
CONCLUSION: These findings, based off a limited set of studies, suggest that there is at least a temporary impact of SES differences onto varied dimensions of HGG treatment and outcomes. Reducing effects with time also suggests that these SES differences might have significant implications for palliative care and quality of life care during HGG treatment protocols. Given limited exploration especially outside of HGGs, further studies that investigate more detail onto SES are warranted, particularly in the dimensions of early-diagnosis and palliative care.