Journal of neuro-oncology · 2026
Divided care, diminished outcomes? The impact of care fragmentation on survival in glioblastoma.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Ghaith Hazem S, Zaidan Saud K, McIntyre Matthew K, Gerges Castro Christina E, Abdou Ahmed, Henn Matthew C, Gendreau Julian, Shafie Beck, Lopez Ramos Christian G, Nugent Joseph G, Yamamoto Erin A, Tora Muhibullah, Bowden Stephen G, Puri Sushant, Sanusi Olabisi R, Raslan Ahmed M
Аннотация
PURPOSE: The impact of fragmentation of care (FC) on glioblastoma (GBM), a malignancy requiring coordinated multimodal therapy, remains unknown. We aimed to identify factors associated with FC and evaluate effects on treatment delays and survival.
METHODS: Patients with GBM diagnosed between 2004 and 2022 were identified from the National Cancer Database. Multivariable logistic regression, Kaplan-Meier analysis, and Cox proportional hazards modeling were performed.
RESULTS: Of 42,390 patients, 22,478 (53.0%) received FC. FC was associated with longer time to radiation (37 vs. 35 days; p < 0.001) and chemotherapy (36 vs. 34 days; p < 0.001), and higher rates of delayed adjuvant treatment, defined as adjuvant therapy > 42 days after surgery (19.6% vs. 14.4%; p < 0.001). The strongest predictors of FC were patient distance and non-academic facility type. Black race (OR 0.82, 95% CI 0.75-0.91; p < 0.001) and low socioeconomic status (OR 0.88, 95% CI 0.82-0.94; p < 0.001) were independently associated with decreased odds of FC. Median overall survival was shorter in FC patients (14.6 vs. 15.2 months; p = 0.0005), and FC was independently associated with worse survival (aHR 1.02, 95% CI 1.00-1.05; p = 0.038). Subgroup analysis revealed worse survival with FC at academic and integrated network facilities, but improved survival at community and comprehensive community programs.
CONCLUSIONS: FC is prevalent in GBM and independently associated with treatment delays and worse survival, though the prognostic impact varies by facility type. FC was associated with improved survival at community programs, suggesting fragmentation may reflect purposeful referrals to specialized centers. Improved care coordination, particularly at academic centers, is needed.
METHODS: Patients with GBM diagnosed between 2004 and 2022 were identified from the National Cancer Database. Multivariable logistic regression, Kaplan-Meier analysis, and Cox proportional hazards modeling were performed.
RESULTS: Of 42,390 patients, 22,478 (53.0%) received FC. FC was associated with longer time to radiation (37 vs. 35 days; p < 0.001) and chemotherapy (36 vs. 34 days; p < 0.001), and higher rates of delayed adjuvant treatment, defined as adjuvant therapy > 42 days after surgery (19.6% vs. 14.4%; p < 0.001). The strongest predictors of FC were patient distance and non-academic facility type. Black race (OR 0.82, 95% CI 0.75-0.91; p < 0.001) and low socioeconomic status (OR 0.88, 95% CI 0.82-0.94; p < 0.001) were independently associated with decreased odds of FC. Median overall survival was shorter in FC patients (14.6 vs. 15.2 months; p = 0.0005), and FC was independently associated with worse survival (aHR 1.02, 95% CI 1.00-1.05; p = 0.038). Subgroup analysis revealed worse survival with FC at academic and integrated network facilities, but improved survival at community and comprehensive community programs.
CONCLUSIONS: FC is prevalent in GBM and independently associated with treatment delays and worse survival, though the prognostic impact varies by facility type. FC was associated with improved survival at community programs, suggesting fragmentation may reflect purposeful referrals to specialized centers. Improved care coordination, particularly at academic centers, is needed.