The implementation gap that I would like to investigate more is completion of standard of care Stupp protocol therapy for under- or uninsured patients with glioblastoma (GBM). Glioblastoma is the most aggressive form of primary malignant brain tumor and carries a poor prognosis. Treatment involves tissue diagnosis either with biopsy, surgical debulking, or surgical resection plus adjuvant chemotherapy and radiation, defined as the Stupp protocol.
Stupp and colleagues performed a randomized controlled clinical trial that compared radiation alone to radiation plus temozolomide chemotherapy following tissue diagnosis for the treatment of patients who were newly diagnosed with GBM (Stupp 2005). The authors concluded that radiation plus chemotherapy led to significantly improved overall survival and progression-free survival. This result was published in 2005 and since then has been accepted as the standard of care treatment for patients with GBM and referred to as the Stupp protocol. A multidisciplinary team of neurosurgeons, neuro-oncologists, and radiation oncologists work together to implement this Stupp protocol for patients with newly diagnosed GBM. Though the Stupp protocol is known to improve survival, patients who are under or un-insured and patients with lower health literacy which often tracks with a lower socioeconomic position do not complete and sometimes do not even start the treatment regimen. Failure to complete the defined chemotherapy and radiation therapy protocol leads to a statistically significant difference in survival. Patients who complete Stupp therapy have a 26.5% two-year survival rate compared to 10.4% for those who do not and the median survival time is 14.6 months for those who complete treatment compared to 12.1 months for those who do not.
I would like to understand more about the barriers that people from vulnerable populations who have been diagnosed with GBM face in receiving standard of care treatment and which of these factors are modifiable.
Reference:
Stupp R et al. (2005). Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma. NEJM, 352: 987-96.