UNDERSTANDING CARE AND OUTCOMES FOR ADULTS WITH GBM AT A WHOLE POPULATION LEVEL

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Abstract AIMS GBM is the commonest malignant brain tumour in adults, with a poor prognosis. For patients who are well enough, optimal therapy is well defined. However, many patients are not well enough to have optimal treat- ment, and there is little data on treatment or outcomes outcomes across a whole population. We used the Gliocova data to explore patterns of care and outcome across a multi-year incident cohort in England. METHODS We identified all adult patients with a GBM diagnosed in England 2013 – 2018. We identified major patterns of treatment: aggressive (analogous to Stupp chemo-radiotherapy), intermediate (some combination of radiotherapy and/or chemotherapy) surgery only and no treatment. We calculated survival rates for each group and used a recent systematic review to identify treatments that have been shown to improve survival RESULTS There were 15 294 patients diagnosed over 6 years. Median survival in the whole cohort was 7 months. 79% of patients had some treatment: 29% had aggressive treatment; 32% had intermediate treatment; 18% had surgery or biopsy alone;11% had no treatment. Median survival in these four groups was 16, 9, 2 and 2 months. Receipt of treatment and survival were significantly correlated with age. There are three recent trials with an improvement in survival; 2 of these are applicable to the aggressively treated group, and 1 to some in the intermediate group. CONCLUSION Population-based survival for patients with GBM is poor. 29% of patients have surgery or biopsy alone or no treatment, and the same number have aggressive treatment. Most clinical trials focus on improving outcomes in the aggressively treated cohort; this will have a limited effect on whole-population survival. There is an urgent need to match research to patient need, especially to improve outcomes in the intermediate treatment group, and reduce unneccessary treatment in those who have surgery/biopsy alone.

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