884 Frailty and Socioeconomic Status Predict Outcome in Newly Diagnosed Glioblastoma Patients

Abstract

INTRODUCTION: Identification of molecular markers of glioblastoma (GBM) prognosis has not often led to meaningful intervention. Individual patient and socioeconomic factors are underexplored prognostic factors. Frailty, a measure of physiological vulnerability, and area deprivation, a measure of socioeconomic status, are easily obtained during the preoperative evaluation. Moreover, both are amenable to intervention; the medical conditions that contribute to frailty can be optimized prior to surgery, while barriers to health care (physical, financial, and cultural) can be addressed for patients at risk socioeconomically. METHODS: This is a retrospective review of patients with newly diagnosed GBM undergoing surgery from 2015 through 2020. Demographic and tumor specific data were recorded. Additionally, the 5-factor modified frailty index (mFI-5) and national area deprivation index (ADI) were determined for each patient. RESULTS: There were 244 patients. Compared to patients in the “some or no” frailty category, patients with “significant” frailty had a shorter median survival: 273 days (95% CI 126-339) vs 393 days (95% CI 317-458), p = 0.008. The median survival for patients living in the most disadvantaged neighborhoods, 210 days (95% CI 134-334), is significantly lower than for those living in the least, 384 days (95% CI 239-484), p = 0.17. Twenty-five percent of patients living in the most disadvantaged neighborhoods did not receive postoperative chemoradiation compared to 11% of patients in the least disadvantaged neighborhoods, p=0.046. Similarly, patients of color were less likely to receive standard of care chemoradiation than white patients. CONCLUSIONS: Both increasing frailty and neighborhood disadvantage are associated with worse outcome in newly diagnosed GBM patients undergoing surgery. Patients living in the most deprived neighborhoods and patients of color are less likely to receive postoperative chemoradiation. Identification of non-traditional predictors of treatment and outcome will lead to mitigation strategies.