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Description
Brain cancers are one of the deadliest cancers in the United States. Because of this treatment patterns for brain cancer patients, greatly impact survival time. Few studies have looked at patterns of care, and none have looked at patterns of care specifically in San Diego or California. The purpose of this retrospective study was to look at patterns of care and survival for brain and other central nervous system cancer patients in San Diego and California from 1999-2008. Patients in four different groups were included in the study: those treated in San Diego with any type of brain cancer (n=3181), those treated in California with any type of brain cancer (n=37,659), those treated in San Diego with glioblastoma (GBM) or anaplastic astrocytoma (AA) (n=856) and those treated in California with glioblastoma or anaplastic astrocytoma (n=10,122). More detailed analysis was performed for those in San Diego and California with glioblastoma or anaplastic astrocytoma. Treatment patterns were compared for patients treated at UCSD vs. other San Diego hospitals and found that those treated at UCSD were more likely to have had surgery as a first course of treatment than those treated at other San Diego hospitals. Those treated at UCSD were just as likely have received radiation or chemotherapy as a first course of treatment. There was no difference in survival rates for those treated at UCSD vs. those treated at other San Diego hospitals. There were also differences in treatment patterns by hospital size, SES and age in San Diego. Treatment patterns were also compared for those treated in San Diego vs. those treated at other California hospitals. Those treated in San Diego were less likely to receive surgery as a first course of treatment than those treated at other California hospitals. Those treated at other California hospitals were 12% less likely to die from GBM or AA between 1999-2008, than those treated at San Diego hospitals. There were significant differences in treatment by sex, age, SES, and academic medical center in California. Survival was significantly associated with radiation, surgery and chemotherapy as a first course of treatment in San Diego and California, but this relationship changed over time. Those who did not receive radiation, chemotherapy or surgery as a first course of treatment were more likely to die soon after diagnosis, but this association dissipated as time went on. Overall, there were significant differences in patterns of care, which also appeared to influence survival rates. This study shows that there is a need for improvements in patterns of care in San Diego, especially for glioblastoma and anaplastic astrocytoma patients.
