A Surveillance, Epidemiology and End Results-Medicare data analysis of elderly patients with glioblastoma multiforme: Treatment patterns, outcomes and cost

Abstract

Abstract. The Surveillance, Epidemiology and End Results (SEER) database was used to determine the treatment patterns, outcomes and cost of therapy in elderly patients with glioblastoma multiforme (GBM). The SEER-Medicare linked database was used to identify patients aged >66 years with GBM diagnosed between 1997 and 2009. The patients were stratified by initial treatment following diagnostic surgery (resection or biopsy) into 6 groups as follows: No treatment, standard radiation therapy (SRT) with and without concurrent temozolomide (TMZ), hypofractionated RT (HRT) with and without concurrent TMZ, or TMZ alone. The 3,759 patients identified had a median age of 74 years (range, 66-97 years). A total of ~48% of the patients received SRT without TMZ; ~10% received SRT with concurrent TMZ; ~29% received no treatment; ~10% received HRT without TMZ; ~1% received HRT with TMZ; and <1% received TMZ alone. Untreated patients had a median survival of 2 months (range, 0-89 months). Patients treated with SRT with and without concurrent TMZ had a median survival of 11 and 9 months, respectively (P=0.01). Patients treated with HRT with and without TMZ or TMZ alone had a median survivals of 3 months [adjusted hazard ratio (AHR)=0.48; 95% confidence interval (CI): 0.36-0.66], 4 months (AHR=0.55; 95% CI: 0.49-0.62) and 6 months (AHR=0.43; 95% CI: 0.29-0.62), respectively. The median post-surgery total treatment cost for patients receiving HRT with and without TMZ or TMZ alone was 63,915, 42,834 and 48,298 USD, respectively. Standard RT with concurrent TMZ was associated with improved survival, even in patients aged >75 years. HRT with and without concurrent TMZ and TMZ alone improved survival compared to the no treatment group. Therefore, in certain cases, HRT or TMZ alone may be more cost-effective, with similar survival outcomes. The various treatment options highlight the need for geriatric assessment tools to aid in therapeutic decision making.

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

“…Those results are similar to findings reported in other retrospective analyses of elderly gbm patients [15][16][17][18] . Among elderly patients who received radiotherapy, os was found to be prolonged in those who had received combined-modality treatment: median survival was 11.3 months in patients who received chemoradiation compared with 4.6 months in those treated with radiation only.…”

“…In a retrospective analysis of American patients more than 65 years of age with a new diagnosis of gbm between 1997 and 2009, median survival ranged between 2 months (for patients who received no postoperative therapy) and 11 months (for those who received standard combined chemoradiation). In addition, increasing age beyond 65 years was associated with shorter survival, with patients 65-75 years of age surviving a median of 8 months after diagnosis, compared with 4 months for patients 75 years of age and older 17 .…”

“…The observed difference in os might therefore suggest a degree of more aggressive tumour biology in older patients, because those patients were otherwise matched for ps, comorbidities, and treatment. In population-based analyses, median survival in this age group has ranged between 4-9 months [15][16][17][18] . In a retrospective analysis of American patients more than 65 years of age with a new diagnosis of gbm between 1997 and 2009, median survival ranged between 2 months (for patients who received no postoperative therapy) and 11 months (for those who received standard combined chemoradiation).…”

Patterns of care and predictors of adjuvant therapies in elderly patients with glioblastoma: An analysis of the National Cancer Data Base

“…12,22 In addition to age, patient demographic and treatment factors, including sex, race, and treatment facility type, predict the receipt of adjuvant therapy. The youngest patients in our study were significantly more likely to receive adjuvant therapy with CRT, CT, or RT than no adjuvant therapy compared with the oldest patients.…”

Outcomes of Treatment for Glioblastoma Multiforme in Adult Patients: A Single Institution Experience from the Eastern Black Sea Region of Turkey

“…Various studies in the literature have revealed that age is the most common and important prognostic variable for GBM. 20,21 Notably, according to our results, age alone is an important factor in the decision-making for treatment selection. Nevertheless, the most suitable treatment option should not be selected on the basis of the age factor alone, it should, in fact, consider the patient's overall health status, desires, and expectations.…”