Addressing the need for more equitable neuro-oncology care requires attention to existing disparities in neuro-oncologic care journey and outcomes. This is particularly important among frail patients with adverse psychosocial and environmental factors.
Growing evidence supports a clear correlation between psychosocial and economic factors and disease outcomes in cancer patients. Recently, an increasing attention on this issue has been also dedicated in neurooncological patients, but research data analyzing the impact of socioeconomic factors on prognosis reported controversial data and inconclusive results.
However, literature data specifically addressing economic factors in neurooncology is scarce and affected by several methodological limits, with large heterogeneity of financial toxicity and economic status methods of assessment.
The term financial toxicity (FT) has been utilized in the last decades to highlight the impact that the financial burden of care may have on patients quality of life and access to optimal cancer care.1
But, currently, standardized measures to better understand the multidimensionality of FT are lacking. Several factors have been reported to influence financial burden in cancer patients. Among them, not only income but also age, race and ethnicity, lower educational level, and change in job status may affect financial burden with negative effects on the well-being and quality of life of patients and their families. Also, treatment adherence and equitable access to cancer care may be influenced by financial distress.
In this issue of Neuro-Oncology Practice, Di Nunno and colleagues reported the results of a systematic literature review exploring the impact of economic income on clinical outcomes of patients with glioma including glioblastoma (GBM).2
The results of this metanalysis, based on 12 studies, suggest a negative association between economic income and survival outcomes of GBM patients, regardless of the type of healthcare system, whether public or privatized.
Although the limits of the studies selected in this review, mainly due to the retrospective design and the large heterogeneity in the assessment of economic variables, the results obtained in a pooled large population of 143.303 GBM patients, show that a low economic income resulted in a worse survival. The possible influence of different Health Systems has been also evaluated in this review but interestingly the presence of a public or private system did not affect the survival outcome.
These results emphasize the need of prospective research in neurooncology addressing the role of socioeconomic determinants of health not only as prognostic factors but also as a barrier to equitable access to treatments and clinical trials for more disadvantaged patients.3 Moreover, other recent studies have reported a correlation between lower socioeconomical status and neurological symptoms like neurocognitive decline and mood depression among adult patients with brain tumors.4
Several oncological studies in different population of patients focusing on financial burden influence in cancer care, reported that socio-economic factors represent a possible cause of disparity in treatments access and adherence.5 Also, financial burden may affect informal caregivers leading to lower quality of life and distress for patients’ families.
Several strategies have been advocated to mitigate these disparities, including attention to healthcare access, policy, and involvement of community for improved disease management. Mitigation strategies should be applied both at care provider level, assessing patients and family socioeconomic frailty, and at health system level, improving social support and patients’ rights access.
Different interventions of support have been suggested including social group membership, family support, and social support.
Given the complex care trajectory of neurooncological patients and their poor prognosis, there is a great need of new instruments to promote equality in healthcare access and improve outcomes in GBM patients presenting economic disadvantage. Although there are few studies specifically examining these determinants within the neurooncology population, the current literature suggests that low socioeconomic status has multiple effects on quality of life and prognosis and represent an important contributing factor to health inequities.
References
- 1. Chan A, Ke Y, Tanay M, et al. Financial toxicity in cancer supportive care: an international survey. JCO Glob Oncol. 2024;10(1):e2400043. [DOI] [PubMed] [Google Scholar]
- 2. Di Nunno V, Gatto L, Aprile M, Bartolini S, Tosoni A, Franceschi E.. Economic Income and survival in patients affected by glioblastoma: a systematic review and meta-analysis. Neurooncol Pract. 2024;11(5):546–555. [Google Scholar]
- 3. Stockdill ML, King A, Johnson M, et al. The relationship between social determinants of health and neurocognitive and mood-related symptoms in the primary brain tumor population: a systematic review. Neurooncol Pract. 2024;11(3):226–239. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Cote DJ, Ostrom QT, Gittleman H, et al. Glioma incidence and survival variations by county-level socioeconomic measures. Cancer. 2019;125(19):3390–3400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Coughlin SS. Social determinants of health and cancer survivorship. J Environ Health Sci. 2021;7(1):11–15. [PMC free article] [PubMed] [Google Scholar]