Survival Outcomes for Glioblastoma in Rural America: A Decade at a Quaternary Care Center

Overview

This retrospective cohort study of 380 adults with IDH-wildtype glioblastoma treated at a quaternary care center in West Virginia found that standardized, centralized neuro-oncology care resulted in comparable survival outcomes between rural and non-rural patients. Treatment adherence, including surgery, radiation, and temozolomide use, was a key determinant of overall survival.

Background

Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults, with a median overall survival of approximately 14.6 months in clinical trials but often shorter in real-world settings. Rural patients face significant barriers to care, including travel distances, delayed referrals, and lower treatment adherence, which may worsen outcomes. Prior studies have suggested rural residence increases mortality risk in CNS cancers, but data specific to GBM are limited. Centralized multidisciplinary care may mitigate these disparities.

Data Highlights

Key Findings

• Among 380 patients with IDH-WT GBM, 66.8% received temozolomide, 88.4% underwent surgical resection, and 59.5% received radiation therapy.
• Rural residence was defined using RUCA codes; a significant portion of patients came from rural areas in West Virginia.
• Standard-of-care treatment completion was strongly associated with improved overall survival.
• Survival outcomes did not differ significantly between rural and non-rural patients when treated within a centralized, high-volume neuro-oncology program.
• Centralized care facilitated uniform diagnostic workup, treatment planning, and follow-up, potentially mitigating geographic disparities.

Clinical Implications

Ensuring access to centralized, multidisciplinary neuro-oncology care can improve treatment adherence and survival outcomes for GBM patients regardless of rural or urban residence. Regional referral networks should prioritize facilitating timely access to comprehensive care for rural populations to overcome geographic and socioeconomic barriers. Clinicians should emphasize completion of multimodal therapy including surgery, radiation, and temozolomide to optimize patient prognosis.

Conclusion

Centralized neuro-oncology care at a quaternary center in a predominantly rural state achieved comparable survival outcomes for GBM patients across rural and urban settings, highlighting the importance of uniform treatment delivery in mitigating rural disparities. These findings support health policy efforts to enhance access to specialized neuro-oncology services in underserved regions.

References

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2. Louis et al. 2021 -- WHO Classification of Tumors of the Central Nervous System
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13. West Virginia Department of Health 2023 -- Rural Health Infrastructure
14. USDA ERS 2024 -- Rural-Urban Commuting Area Codes