Racial Disparities in Recommendation of Resective Surgery Undermines Treatment of Brain Tumors

Vignesh Subramanian ’24

Figure 1: Glioblastoma multiforme (GBM), the most common type of malignant brain tumor in adults.

Brain tumors—abnormal and typically cancerous growths of uncontrollably multiplying cells—are often first treated using a surgical approach. Benign and malignant brain tumors may be addressed with excision (partial removal) or resection (complete removal) procedures once an evaluation of surgical indications has established their necessity. As such, these procedures require the physicians with whom patients consult—whether neurosurgeons, oncologists, neurologists, or other specialties—to explicitly recommend that an operation be performed. However, broad-based racial disparities in treatment outcomes have become increasingly scrutinized in recent decades, with some researchers shifting their attention to a major contributing factor: the initial treatment recommendation. In a study at the University of Minnesota, researchers led by Dr. Venteicher aimed to characterize racial disparities in recommendations for surgery for patients with primary, or brain tissue-originating, brain tumors.

The researchers first sampled over 600,000 adult patients logged in the national Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB) over a roughly 40 year span. The total sample included over 400,000 patients with benign brain tumors (meningiomas, pituitary adenomas, and vestibular schwannomas) and nearly 200,000 with malignant brain tumors (glioblastomas, astrocytomas, and oligodendrogliomas). This patient pool was then categorized by race, insurance status, and a residence-based rural-urban continuum code. Finally, regression and multivariable analyses were applied to identify demographic characteristics associated with recommendations that did not include or were against clinically indicated surgery. 

The researchers found that Black patients, in particular, were less likely to be recommended to pursue surgery for four types of brain tumors: all three benign tumors and glioblastoma, a cancerous and typically life-threatening tumor. Specifically, Black patients were found to collectively be 14% to 19% less likely to receive the indicated resection procedure for malignant tumors and up to 48% less likely to receive it for benign tumor conditions, even after other clinical factors (including determination of the localization, size, and stage of the tumors examined) were statistically accounted for. However, while largely unexplained by other demographic factors, this evident racial divide in recommendations improved over the 40 years examined and effectively closed in the most recent decade included (2010-2017). While this offers hope that the influence of potential implicit racial biases over clinical decision-making is diminishing, work to eliminate them remains unfinished.

Works Cited:
[1] A. Venteicher, et al., Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis. The Lancet 400, 2063-2073 (2022). doi: 10.1016/S0140-6736(22)00839-X
[2] Image retrieved from: https://commons.wikimedia.org/wiki/File:Glioblastoma_macro.jpg


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