In a U.S. registry-based cohort study reported in The Lancet, Butterfield et al found that Black patients were significantly more likely than White patients to receive recommendations against surgical resection for multiple types of newly diagnosed brain tumors.
Study Details
The study included data from the Surveillance, Epidemiology, and End Results (SEER) registry from 1975 to 2016 and the National Cancer Database from 2004 to 2017 on patients aged > 20 years with newly diagnosed brain tumors and information on tumor size and surgical recommendation. The SEER and National Cancer Database cohorts consisted of, respectively: 63,674 and 222,673 patients with meningioma; 35,258 and 104,047 with glioblastoma; 27,506 and 87,772 with pituitary adenoma; 11,525 and 30,745 with vestibular schwannoma; 5,402 and 10,631 with astrocytoma; and 3,977 and 9,187 with oligodendroglioma.
Key Findings
On multivariate analysis—including clinical, demographic, and socioeconomic factors—in the SEER cohort, with White patients as the reference category, significantly greater likelihood of recommendation against surgical resection was observed for:
- Black patients for meningioma (adjusted odds ratio [aOR] = 1.20, P < .0001), glioblastoma (aOR = 1.16, P = .018), pituitary adenoma (aOR = 1.19, P < .0001), and vestibular schwannoma (aOR = 1.56, P < .0001)
- Patients of unknown race for pituitary adenoma (aOR = 1.92, P < .0001) and vestibular schwannoma (aOR = 1.56, P = .0045)
- Hispanic patients for glioblastoma (aOR = 1.19, P = .0025)
- Asian/Pacific Islander patients for glioblastoma (aOR = 1.27, P = .0021).
Older age at diagnosis was associated with significantly greater likelihood of recommendation against surgery for meningioma, glioblastoma, pituitary adenoma, and vestibular schwannoma.
Compared with White patients, significantly lower likelihood of recommendation against surgery in the SEER cohort was observed for Hispanic patients for meningioma (aOR = 0.86, P < .0001) and Asian/Pacific Islander patients for pituitary adenoma (aOR =0.85, P <.007).
Multivariate analysis in the National Cancer Database validation cohort confirmed the significant findings for Black vs White patients with meningioma (aOR = 1.18, P < .0001), glioblastoma (aOR = 1.19, P < .0001), pituitary adenoma (aOR = 1.21, P < .0001), and vestibular schwannoma (aOR = 1.19, P = .0085).
In analysis restricted to patients in the SEER cohort diagnosed in 2010 or later to test for temporal trends, inequities for Black vs White patients were observed for meningioma (aOR = 1.18, P < .0001), pituitary adenoma (aOR = 1.20, P < .0001), and vestibular schwannoma (aOR = 1.54, P = .0031), but not for glioblastoma (aOR = 1.14, P = .20).
The investigators concluded, “Racial disparities in surgery recommendations in the [United States] exist for patients with primary brain tumors, independent of potential confounders including clinical, demographic, and select socioeconomic factors. Further studies are needed to understand drivers of this bias and enhance equality in surgical care.”
Andrew S. Venteicher, MD, of the Department of Neurosurgery, University of Minnesota, Minneapolis, is the corresponding author for The Lancet article.
Disclosure: The investigators reported that there was no external funding for the study. For full disclosures of the study authors, visit thelancet.com.
