Black patients more likely to be advised against brain tumor surgery

Black patients are significantly more likely to receive a recommendation against surgical resection of glioblastoma, meningioma, pituitary adenoma, and vestibular schwannoma than White patients, according to a study published in the Dec. 10 issue of The Lancet.

John T. Butterfield, from the University of Minnesota in Minneapolis, and colleagues conducted a registry-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database (1975 to 2016) and the American College of Surgeons National Cancer Database (NCDB) to examine racial and socioeconomic disparities in surgical management of brain tumors.

The researchers found that compared with White patients, Black patients had significantly increased odds of recommendation against surgical resection of meningioma, glioblastoma, pituitary adenoma, and vestibular schwannoma in the SEER database, independent of clinical and demographic factors, including insurance status and rural-urban continuum code (adjusted odds ratios, 1.13, 1.14, 1.13, and 1.48, respectively).

The odds of recommendation against surgical resection were also increased for pituitary adenoma and vestibular schwannoma among patients of unknown race (odds ratios, 1.80 and 1.49, respectively). The findings for Black patients were confirmed in a validation analysis using the NCDB dataset (odds ratios, 1.18, 1.19, 1.21, and 1.19 for meningioma, glioblastoma, pituitary adenoma, and vestibular schwannoma, respectively).

"These results provide a basis for future studies to gain further insight into unrecognized bias in the surgical management of neuro-oncological diseases," the authors write. "Crucial next steps include understanding sources for physician unconscious bias, determining the impact of such bias on patient outcomes, and identifying mechanisms to reduce bias."

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