Abstract Details

United States residents of rural counties have a higher cancer-associated mortality than their urban and suburban counterparts. This trend has been shown in multiple cancer types, but the impact of rurality is under-studied in glioblastoma.

To examine clinical presentation, treatment, and outcomes in patients with newly diagnosed glioblastoma from urban and rural counties in Vermont and New York presenting to a single tertiary medical center in Vermont, the country’s most rural state.  

In this IRB-approved retrospective cohort study of adult patients with newly diagnosed glioblastoma treated at the University of Vermont Medical Center (UVMMC) (01/2017-12/2021), urban vs rural was determined by US Department of Agriculture Rural-Urban Continuum Codes (1-3=urban; 4-9=rural) for county of residence. Correlates were assessed using Chi-Square test on SPSS (p-value <0.05).

Our study included 119 patients, 68 rural and 51 urban. Urban and rural patients were of similar age (median 63 vs 64.5), KPS (70 for each), gender, ethnicity, and sex. Time between symptom onset and neurosurgery was insignificantly different: 49 days for rural patients and 82 for urban patients. Percent receiving gross total resection was similar (44% rural vs 47% urban), with no difference in MGMT methylation (43% rural, 47% urban) or IDH mutation (6% rural, 4% urban.  80% of rural patients vs 78% urban received radiation (median 60Gy vs 58Gy), and 78% in each group received adjuvant temozolomide (median 3 vs 1.5 cycles, rural/urban).  Median progression free survival was 5.9 months for rural patients vs 3.6 months for urban (p>0.05), and overall survival was 11.9 vs 8.7 months, respectively, (p>0.05).

Urban and rural patients with glioblastoma at UVMMC had similar presentation, treatment, and outcomes.  We hypothesize that access to a tertiary hospital centrally located in a rural catchment area for neuro-oncologic management may help mitigate the disparities rural patients face when accessing cancer care.