Disparities in Neuro-Oncology

Michaelson, Nara Miriam; Watsula, Amanda; Bakare-Okpala, Anu; Mohamadpour, Maliheh; Chukwueke, Ugonma N.; Budhu, Joshua A.

doi:10.1007/s11910-023-01314-x

Cited by 6 publications

(1 citation statement)

References 103 publications

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“…The average annual mortality related to CNS malignancies is 4.41 per 100,000 people, representing more than 15,000 deaths per year in the United States alone. Importantly, disparities exist with inadequate access to care, inability to receive optimal treatment, higher complication rates, and shorter life expectancy for adults and children with CNS tumors 3-6 …”

Section: Introductionmentioning

confidence: 99%

Neuro-oncologic Emergencies

Maciel,

Busl

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE Neuro-oncologic emergencies have become more frequent as cancer remains one of the leading causes of death in the United States, second only to heart disease. This article highlights key aspects of epidemiology, diagnosis, and management of acute neurologic complications in primary central nervous system malignancies and systemic cancer, following three thematic classifications: (1) complications that are anatomically or intrinsically tumor-related, (2) complications that are tumor-mediated, and (3) complications that are treatment-related. LATEST DEVELOPMENTS The main driver of mortality in patients with brain metastasis is systemic disease progression; however, intracranial hypertension, treatment-resistant seizures, and overall decline due to increased intracranial burden of disease are the main factors underlying neurologic-related deaths. Advances in the understanding of tumor-specific characteristics can better inform risk stratification of neurologic complications. Following standardized grading and management algorithms for neurotoxic syndromes related to newer immunologic therapies is paramount to achieving favorable outcomes. ESSENTIAL POINTS Neuro-oncologic emergencies span the boundaries of subspecialties in neurology and require a broad understanding of neuroimmunology, neuronal hyperexcitability, CSF flow dynamics, intracranial compliance, and neuroanatomy.

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Section: Introductionmentioning

confidence: 99%

Neuro-oncologic Emergencies

Maciel,

Busl

2024

CONTINUUM: Lifelong Learning in Neurology

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Racial/ethnic disparities in all-cause and cause-specific death among children with malignant central nervous system tumours: a registry-based cohort retrospective analysis

Wang,

Yao,

Tang

et al. 2024

eClinicalMedicine

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Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort

Budhu,

Chukwueke,

Jackson

et al. 2023

Neuro-Oncology

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Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies which contradicts the principle of distributive justice; as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will improve patient care.

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Disparities in Neuro-Oncology

Cited by 6 publications

References 103 publications

Neuro-oncologic Emergencies

Neuro-oncologic Emergencies

Racial/ethnic disparities in all-cause and cause-specific death among children with malignant central nervous system tumours: a registry-based cohort retrospective analysis

Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort

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